HBsAg and anti-HCV screening in elderly hospitalized patients of a German tertiary referral centre

Abstract

Background: Elderly patients are under-represented in hepatitis B and C screening approaches, but may be at increased risk for advanced liver disease. We therefore screened a hospitalized elderly population.

Materials and methods: 6011 admissions to the department of internal medicine and neurology within one year were screened for HBsAg and anti-HCV (Elecsys^®-HBsAg and -anti-HCV). Positive anti-HCV results were confirmed with the INNO-LIA™ assay. HCV-RNA was analyzed by real-time PCR in the case of confirmed positive anti-HCV results, HBV-DNA in the confirmed HBsAg positive individuals.

Results: Patient´s mean age (62.4 years) was 19 years above that of the average German population. The confirmed HBsAg prevalence was 0.6 %. 34 % (n = 12/35) of HBsAg positive cases were newly diagnosed, three of them presented with HBV-DNA levels > 2000 IU/mL. The confirmed anti-HCV prevalence was 0.9 %. 14 % (n = 8/56) of anti-HCV positive patients were previously undiagnosed. HCV-RNA was positive in three of them. In newly diagnosed individuals cirrhosis was present in 1/12 of the HBsAg and in 3/8 of the anti-HCV positive individuals. Compared to non-infected controls, the following risk factors were significantly more frequent in infected patients: (i) HBsAg: sexual exposure (20 % vs. 2 %), blood transfusion before 1992 (13 % vs. 6 %), referrals from nursing homes (10 % vs. 1 %). (ii) Anti-HCV: blood transfusion before 1992 (41 % vs. 6 %), IVDU (25 % vs. 0.5 %), organ transplantation (20 % vs. 5 %), hemodialysis (11 % vs. 3 %).

Conclusions: HBsAg and anti-HCV were underdiagnosed in a senescent population, however, only few cases presented with advanced liver disease. Referrals from nursing homes were at increased risk for HBV infection.

Zusammenfassung

Hintergrund: Ältere Patienten sind bei Hepatitis B- und -C-Screeningprojekten häufig unterrepräsentiert, können jedoch eine fortgeschrittene Lebererkrankung aufweisen. Es wurde daher eine Population, die älter als die deutsche Allgemeinbevölkerung ist, im Rahmen eines stationären Krankenhausaufenthalts gescreent.

Material und Methoden: 6011 Einweisungen in das Department für Innere Medizin und Neurologie wurden innerhalb eines Jahres auf HBsAg und anti-HCV untersucht (Elecsys^®-HBsAg und -anti-HCV). Positive anti-HCV-Befunde wurden mit dem INNO-LIA™-Test bestätigt. Bei positivem Bestätigungstest erfolgte eine HCV-RNA-Analyse mittels real-time PCR. Die HBV-DNA (PCR) wurde bei bestätigten HBsAg-positiven Befunden analysiert.

Ergebnisse: Das mittlere Patientenalter (62,4 Jahre) lag 19 Jahre über dem der deutschen Allgemeinbevölkerung. Die HBsAg-Prävalenz betrug 0,6 %. 34 % (n = 12/35) der HBsAg-positiven Fälle wurden neu diagnostiziert, 3 Patienten wiesen eine HBV-DNA > 2000 IU/mL auf. Die anti-HCV-Prävalenz betrug 0,9 %. 14 % (n = 8/56) der anti-HCV-positiven Patienten waren zuvor nicht diagnostiziert. Die HCV-RNA war in 3 dieser Fälle positiv. Eine Zirrhose lag bei den neu diagnostizierten Fällen bei 1/12 der HBsAg-positiven Patienten und bei 3/8 der anti-HCV-positiven Fälle vor. Im Vergleich zu nicht infizierten Kontrollpatienten wurden bei den Hepatitis-Patienten folgende Risikofaktoren identifiziert: (i) HBsAg: Geschlechtsverkehr (20 % vs. 2 %), Bluttransfusion vor 1992 (13 % vs. 6 %), Zuweisung aus einem Pflegeheim (10 % vs. 1 %). (ii) Anti-HCV: Bluttransfusion vor 1992 (41 % vs. 6 %), Drogenabusus (25 % vs. 0,5 %), Organtransplantation (20 % vs. 5 %), Dialyse (11 % vs. 3 %).

Schlussfolgerung: HBsAg und anti-HCV sind bei älteren Patienten unterdiagnostiziert, eine fortgeschrittene Lebererkrankung liegt jedoch nur bei wenigen Fällen vor. Patienten aus einem Pflegeheim haben ein erhöhtes Hepatitis-B-Risiko.

Schlüsselwörter

ältere Patienten - direkt antiviral wirksame Substanzen - Hepatitis B - Hepatitis C - Zirrhose

Key words

elderly people - direct antiviral agents - hepatitis B - hepatitis C - liver cirrhosis

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