A189 POOR ADHERENCE TO HEPATOCELLULAR CARCINOMA SCREENING IN A COHORT OF CIRRHOTIC PATIENTS AFTER HEPATITIS C CURE
Bibliographic record
Abstract
After hepatitis C virus (HCV) cure, there remains a substantial risk of developing hepatocellular carcinoma (HCC) in cirrhotic patients. As screening and early detection greatly improves HCC prognosis, it is important to understand factors influencing adherence to post sustained virologic response (SVR) care to maximize the impact of curative therapy. We evaluated adherence to HCC screening at 6-month intervals in a cohort of cirrhotic patients cured of HCV. Using a retrospective cohort study design, all cirrhotic patients achieving SVR enrolled in the Hepatitis C positive and At-Risk (HEAR) database from April 2014 to April 2016 were extracted for analysis. Health records were reviewed for liver imaging during 6-month intervals post-SVR up to February 28, 2018. Patients were categorized as (1) receiving all follow-up at 6-month intervals, and (2) receiving at least 1 liver image during follow-up. Univariate and multivariate odds ratios were calculated for variables which may impact HCC surveillance. 49 cirrhotic patients were included with a mean follow-up time of 845.6 days (range 219–1043). Four patients (10.6%) had appropriate HCC surveillance at all 6-month intervals while 57.1% (n=28) had at least 1 liver image performed. In univariate analysis, individuals under age 60, those incarcerated or unemployed were significantly less likely to having any imaging performed post SVR; however multivariate analysis did not show any single factor to be predictive of HCC surveillance. Out of the 95 liver imaging tests performed, 44 (46.3%) were ordered by Primary Care, followed by Gastroenterology/Hepatology (28/95, 29.5%) then Infectious Diseases (8/95, 8.5%). Of the 28 patients who received at least 1 liver image, 3 (10.7%) had confirmed HCC. Sub-optimal engagement in HCC surveillance was identified in a cohort of cirrhotic patients after HCV cure. Results did indicate higher percentages not receiving imaging follow-up among injection drug users, prisoners, unemployed persons and those with less education, but the small numbers limited the power of the study. There is a need for comprehensive strategies to ensure ongoing safety of HCV patients across the entire cascade of care, including after HCV cure. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".