Missed Diagnosis of Liver Cirrhosis Leads to Disparities in Care for Older Patients

BACKGROUND: Cirrhosis of the liver is often not recognized until late in the disease state, when patients decompensate or develop hepatocellular carcinoma (HCC). This inquiry considered factors associated with undiagnosed cirrhosis. METHODS: Patients with undiagnosed cirrhosis were compared to patients with known diagnosis of cirrhosis, to evaluate the differences between these two groups. The study population is patients with confirmed diagnosis of HCC, stratified into patients with known diagnosis of cirrhosis (n = 36) and patients without the known diagnosis of cirrhosis who have features of cirrhosis (n = 36). RESULTS: There was no significant difference in insurance, gender, race, etiology of liver disease, presence of splenomegaly, model for end stage liver disease (MELD) score, fibrosis-4 index (FIB-4) or aspartate aminotransferase (AST) to platelet ratio index (APRI) scores between groups. However, the strongest predictor of the diagnosis of cirrhosis was age, with older patients being less likely to be diagnosed with cirrhosis (OR: 0.924, P = 0.012). Furthermore, tumor size in patients without known cirrhosis was larger than those diagnosed with cirrhosis (median: 4.9 cm versus 3.5 cm, P = 0.015). Of note, 50% of cases with cirrhosis were undiagnosed. CONCLUSION: Older age was the most significant predictor of the missed diagnosis of liver cirrhosis. This led to a larger tumor size at diagnosis, which may imply worse prognosis in these patients. Further evaluation of health disparities related to older age and outcomes of older patients with liver cirrhosis should guide the development of guidelines to prevent the missed diagnosis of cirrhosis.