Diagnostic delays in alcoholic cirrhosis: A cross-sectional study of contributing factors

Abstract

BACKGROUND

Studies investigating diagnostic delays and their effects on patients with alcoholic cirrhosis.

AIM

To investigate the current status and associated factors influencing diagnostic delays in 401 patients with alcoholic cirrhosis.

METHODS

A cross-sectional analysis was conducted at a tertiary hospital in China from June 2020 to December 2023. Data were collected through telephone follow-ups and questionnaires. The Wilcoxon and Kruskal-Wallis H tests were used to compare diagnostic delays across various characteristics. Multivariate linear regression was employed to identify factors associated with diagnostic delays.

RESULTS

The median diagnostic delay was 5 months, with an interquartile range of 2-11 months. The proportions of patients with alcoholic cirrhosis who initially visited tertiary, secondary, and primary hospitals were 38.9%, 37.91%, and 23.19%, respectively. Furthermore, the rates of patients undergoing liver computed tomography (CT) during their first visit at tertiary, secondary, and primary hospitals were 92.95%, 13.82%, and 1.08%, respectively (P < 0.001). Significant differences were observed in diagnostic delay-related characteristics, including residence, resident type, initial diagnosis, medical insurance, liver CT, and liver ultrasound during the first visit, age, years of education, family size, marital status, annual family income, years of drinking, daily alcohol consumption, and type of alcohol consumed (P < 0.01). Furthermore, diagnostic delays were variably associated with daily alcohol consumption and other characteristics (i.e. residence, years of drinking, medical insurance, years of education, annual family income, liver CT and ultrasound during the first visit). Significant predictors of diagnostic delay identified on multivariate linear regression analysis included years of education, daily alcohol consumption, annual family income and blood ammonia levels (P < 0.01). Patients with alcoholic cirrhosis experience varying degrees of diagnostic delays, necessitating interventions targeting potential contributing factors.

CONCLUSION

Our study indicates that patients with alcoholic cirrhosis may experience varying degrees of diagnostic delay. Interventions targeting potential factors contributing to diagnostic delay are necessary.

Keywords: Diagnostic delays; Contributing factors; Alcoholic cirrhosis; Diagnostic delay-related characteristics; Interventions

Core Tip: Among 401 patients with alcoholic cirrhosis in China, the median diagnostic delay was 5 months, with significant variations induced by hospital level (tertiary vs primary) and liver computed tomography evaluation. Factors contributing to diagnostic delay included residence, education, income, drinking patterns and initial diagnostic measures. Lower education, higher daily alcohol intake, lower income and elevated blood ammonia were identified as independent predictors on multivariate analysis. Targeted interventions addressing these modifiable factors are crucial to reducing delays and improving outcomes.