Year 2021 / Volume 113 / Number 11
Original
Retrieval and treatment of patients with primary biliary cholangitis who are lost in the health system

776-779

DOI: 10.17235/reed.2021.8174/2021

Antonio Olveira-Martín, Jorge Yebra-Carmona, Carla Amaral-González, Marta Tejedor, Pablo Eirás, María Hernández-Pérez, Carolina Suárez-Cabredo, Isabel Spigarelli-de Rábago, Cristina Suárez-Ferrer, Dalia Morales-Arráez, Inmaculada Chico, Felicitas Díaz-Flores, Raquel Rodríguez, Silvia Llorente, Esther Molina-Pérez, Manuel Nicolás Hernández-Guerra de Aguilar,

Abstract
Introduction: hepatitis C patients loss to follow-up in the health care system has been shown to have negative consequences. This study aimed to investigate this issue as regards primary biliary cholangitis. Methods: the databases (immunology, biochemistry, clinical reports, drug dispensation, appointments) of 4 reference hospitals in Spain (serving a population of 1,450,000 inhabitants) were analyzed. The diagnosis of primary biliary cholangitis was based on an antimitochondrial antibody titer ≥ 1:80, chronically elevated alkaline phosphatase, and the absence of other liver disease. Patients were classified as lost in the absence of reports indicating a diagnosis, specific medical follow-up, and/or treatment with bile salts. Results: a total of 1372 patients with antimitochondrial antibody titers ≥ 1:80 were included between January 2010 and June 2019. A total of 697 (50.8 %) were classified as having primary biliary cholangitis, and 100 patients (14.3 %; 95 % CI: 11.8-17.2) were identified as lost. Of these, 30 were contacted and retrieved. The median age was 70 years, 93 % were female, median alkaline phosphatase was 185 IU/L, 10 % had pruritus, and 27 % had a transient elastography value > 9.5 kPa. The disease was confirmed and ursodeoxycholic acid was started in all 30 patients. Death was liver-related in 6 of the 100 patients classified as lost. Conclusion: up to 14.3 % of patients (1 out of 7) with a definitive diagnosis of primary biliary cholangitis remain undiagnosed, thus preventing monitoring and treatment. More than a quarter are at risk of advanced liver disease and its complications. Patients lost in the system must be identified and retrieved, and searching hospital databases is a suitable approach to meet this goal.
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Olveira-Martín A, Yebra-Carmona J, Amaral-González C, Tejedor M, Eirás P, Hernández-Pérez M, et all. Retrieval and treatment of patients with primary biliary cholangitis who are lost in the health system. 8174/2021


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Publication history

Received: 22/06/2021

Accepted: 04/08/2021

Online First: 02/09/2021

Published: 05/11/2021

Article revision time: 41 days

Article Online First time: 72 days

Article editing time: 136 days


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