Loss to follow-up in anti-HCV-positive patients in a Brazilian regional outpatient clinic

Loss to follow-up (LF), which refers to patients who started care but voluntary stopped it, is a problem for patients with chronic disease. We aimed to estimate the rate of LF among patients seropositive for hepatitis C virus (HCV) and identify possible demographic and lifestyle risk factors associated with LF. From January 2009 through December 2012, 1010 anti-HCV-positive patients were included in the study. Among participants, 223 (22.1%) met the case definition for LF (more than 1-year elapsed since the last clinical appointment). Among 787 patients who remained in follow-up, 372 (47.2%) were discharged after undetectable HCV RNA, 88 (11.1%) were transferred (and remained on regular follow-up at the destination), and 25 (3.1%) died. According to univariate analysis, male gender, absence of a life partner, black race, psychiatric illness, previous alcohol abuse, previous or current recreational drug use, and previous or current smoking were significantly associated with LF. In multivariate analysis, absence of a life partner (adjusted odds ratio (AOR)=1.44; 95% confidence interval (95%CI)=1.03–2.02), black race (AOR=1.81, 95%CI=1.12–2.89), psychiatric illness (AOR=1.77, 95%CI=1.14–2.73), and the presence of at least one lifestyle risk factor (pertaining to substance abuse) (AOR=1.95, 95%CI=1.29–2.94) were independently associated with LF. Our study provides an estimate of the incidence of LF among anti-HCV-positive patients and identifies risk factors associated with this outcome. In addition, these results can help clinicians recognize patients at risk for LF, who require additional support for the continuity of care.

失访（Loss to follow-up, LF）指已开始诊疗但自愿终止的患者，该问题在慢性病患者中尤为突出。本研究旨在估算丙型肝炎病毒（hepatitis C virus, HCV）血清学阳性患者的失访率，并明确与之相关的人口学与生活方式危险因素。2009年1月至2012年12月期间，本研究共纳入1010例抗-HCV（anti-HCV）阳性患者。其中223例（22.1%）符合失访病例定义（末次临床就诊后间隔超过1年）。在仍坚持随访的787例患者中，372例（47.2%）在HCV RNA转阴后出院，88例（11.1%）转诊至其他医疗机构（且在转诊后仍于目的地接受规律随访），25例（3.1%）死亡。单因素分析结果显示，男性、无生活伴侣、黑人种族、精神疾病、既往酒精滥用史、既往或当前娱乐性药物使用，以及既往或当前吸烟均与失访显著相关。多因素分析显示，无生活伴侣（校正比值比（adjusted odds ratio, AOR）=1.44；95%置信区间（95% confidence interval, 95%CI）=1.03~2.02）、黑人种族（AOR=1.81，95%CI=1.12~2.89）、精神疾病（AOR=1.77，95%CI=1.14~2.73），以及至少存在1项与物质滥用相关的生活方式危险因素（AOR=1.95，95%CI=1.29~2.94）均为失访的独立危险因素。本研究估算了抗-HCV阳性患者的失访发生率，并明确了与之相关的危险因素。此外，本研究结果可帮助临床医师识别失访高风险患者，为其提供维持诊疗连续性所需的额外支持。