Abstract
Introduction
Cirrhosis is an end result of a variety of liver diseases characterized by liver fibrosis with the formation of regenerative nodules and can vary with different clinical manifestations and complications. Globally, the prevalence of cirrhosis ranges from 4.5% to 9.5% among the general population. In the past, there have been studies about factors associated with cirrhosis and its complications. However, in Cambodia, knowledge and data on cirrhosis and its associated factors have been poorly documented. Therefore, this study aimed to determine the prevalence and factors associated with cirrhosis among a hepatitis C patient cohort in Kossamak Hospital, Phnom Penh.
Methods
This study analyzed existing data from hepatitis C projects in Kossamak Hospital who were eligible for treatment throughout 2017, with a total sample of 5518 patient records. The data were assessed and checked for completeness, outliers and missing values. Descriptive analysis was used to calculate the prevalence of cirrhosis, mean ages (SD) and biomarkers. Bivariate analysis using the chi-square test was performed to assess the association between sociodemographic characteristics and potential risk factors, including hepatitis B coinfection, diabetes comorbidity, biomarkers (bilirubin, albumin) and cirrhosis. A p-value <0.05 was considered statistically significant.
Results
The prevalence of cirrhosis among hepatitis C cohort patients was 32.5% (95% CI: 31.3% - 33.7%). The majority of the respondents (56.3%) were between 41 and 60 years old. Women represented a higher proportion than men (58.6% vs 41.4%). Of the total sample, 12.2% had comorbidities with diabetes, but 60.8% of cirrhotic patients had diabetes comorbidity. Factors found to be significantly associated with cirrhosis were as follows: men (36.1%) vs. women (30.4%), p value <0.001; age group > 60 years (42.3%) vs. 41-60 years (31.1%), p value <0.001; unemployment; diabetes (60.8%) vs. non-diabetes (28.9%), p value <0.001; and higher levels of biomarkers (i.e., ALT and AST). Moreover, cirrhosis patients were likely to have a lower viral load of less than 800.000 IU/ml.
Conclusion
More than six in ten of the cirrhosis patients had comorbidities with diabetes, with few having HBV coinfection. A number of factors were significantly associated with cirrhosis, including men, older age over 60 years old, unemployment, diabetes comorbidity and some biological markers. Therefore, we recommend that patients with cirrhosis, especially older patients and men, check their HCV status and undergo cirrhosis screening and seek available care services, including treatment for hepatitis C infection. Early detection of HCV or cirrhosis could prevent severe conditions and could prevent further severe consequences related to HVC and cirrhosis, such as hepatic encephalopathy and portal hypertension.