435. Electronic Medical Record-Based Liver Fibrosis Staging: Identification of High-Risk Patients at Time of Hepatitis C Diagnosis in the Emergency Department
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Background: Emergency departments (ED) are high yield hepatitis C virus (HCV) screening sites yet the majority of diagnosed patients fail to establish liver care. To facilitate earlier recognition of cirrhosis and prioritization of linkage to care efforts, we explored the feasibility of using non-invasive markers [Age Platelet Index (API), AST to Platelet Ratio Index (APRI), and FIB-4] and imaging results readily available in Electronic Medical Records (EMR) to stage liver fibrosis at the time of HCV diagnosis. We also report the prevalence of cirrhosis based on these parameters.

Methods: Baby boomers presenting to an urban ED from September 2013 to June 2014 received opt-out HCV screening. In those with confirmed HCV viremia, EMR were queried for platelet, aspartate transaminase (AST), and alanine transaminase (ALT) results, liver imaging (abdominal ultrasound, abdominal CT, abdominal and pelvis CT, and MRI studies), demographics, ICD-9 codes, and medical visit attendance. We examined feasibility by determining the frequency of platelet, AST, ALT, and imaging availability within 6 months of the HCV screening encounter. API, APRI, and/or FIB-4 were calculated for each patient based on available labs. Cirrhosis was determined using validated cut-points for each marker (API≥6, APRI>1.0, FIB-4>3.25).

Results: Analysis included 336 patients [mean age 57.3 years (SD± 4.9), 70% male, 56% African American]. In the HCV screening encounter 318 (95%) patients had at least one platelet count and 200 (60%) had at least one ALT and AST result, respectively. Including labs prior to the screening encounter increased yields for AST and ALT to 68%, but did not improve platelet count availability. Cirrhosis prevalence was 50% (160/318) for API, 33% (75/226) for APRI, and 34% (76/226) for FIB-4 calculations. Findings consistent with cirrhosis were present in 21% (16/75) of patients with available imaging results.

Conclusion: Cirrhosis was highly prevalent among HCV infected baby boomers in this urban ED setting regardless of the non-invasive marker used. Non-invasive fibrosis markers (especially API) may be widely available at the time of HCV screening and facilitate earlier recognition of high-risk patients and prioritization of linkage to care resources.

Julie Schexnayder, DNP, MPH, CRNP1, Ricardo Franco, MD2, Joshua Richman, MD, PhD1,2, James Galbraith, MD2, Deanne Guthrie, MSCS2 and Michael J. Mugavero, MD, MHSc2, (1)Birmingham VA Medical Center, Birmingham, AL, (2)University of Alabama at Birmingham, Birmingham, AL


J. Schexnayder, None

R. Franco, Gilead: Grant Investigator and Scientific Advisor , Consulting fee , Grant recipient and Research support
BMS: Scientific Advisor , Consulting fee
Merck: Investigator , Research support
Janssen: Investigator , Research support

J. Richman, None

J. Galbraith, Gilled Sciences: Grant Investigator , Grant recipient

D. Guthrie, None

M. J. Mugavero, None

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