(A) Characteristics of patients newly presenting with HCV-related decompensated cirrhosis (DC) in the pre-DAA and DAA eras, and (B) results of segmented Poisson regression analyses modelling the trend in the (6-monthly) number of new presentations with HCV-related DC between the pre-DAA and DAA eras (overall and stratified according to patient characteristics)
| Characteristics | (A) New presentations with HCV-related DC, N (%) | (B) Segmented Poisson regression analysis | |||||||
| Pre-DAA era (Jan 2000 to Dec 2014) | DAA era (Jan 2015 to Dec 2018) | Pre-DAA era slope per 6-month period | Change in slope (DAA vs pre-DAA era) | DAA era slope per 6-month period | |||||
| RR (95% CI) | P value | RR (95% CI) | P value | RR (95% CI) | P value | ||||
| Total | 1302 (100) | 404 (100) | 1.04 (1.04 to 1.05) | <0.001 | 0.88 (0.85 to 0.90) | <0.001 | 0.92 (0.89 to 0.94) | <0.001 | |
| Sex | Female | 333 (26) | 112 (28) | 1.05 (1.04 to 1.06) | <0.001 | 0.86 (0.81 to 0.91) | <0.001 | 0.90 (0.85 to 0.95) | <0.001 |
| Male | 969 (74) | 292 (72) | 1.04 (1.03 to 1.05) | <0.001 | 0.88 (0.85 to 0.91) | <0.001 | 0.92 (0.89 to 0.95) | <0.001 | |
| Age (years) | <50 | 827 (64) | 191 (47) | 1.04 (1.03 to 1.04) | <0.001 | 0.85 (0.81 to 0.88) | <0.001 | 0.88 (0.84 to 0.91) | <0.001 |
| 50+ | 475 (36) | 213 (53) | 1.06 (1.05 to 1.07) | <0.001 | 0.90 (0.87 to 0.94) | <0.001 | 0.96 (0.92 to 0.99) | 0.014 | |
| Alcohol admission pre/at DC | No | 655 (50) | 183 (45) | 1.04 (1.03 to 1.05) | <0.001 | 0.87 (0.83 to 0.91) | <0.001 | 0.90 (0.87 to 0.94) | <0.001 |
| Yes | 647 (50) | 221 (55) | 1.05 (1.04 to 1.06) | <0.001 | 0.88 (0.84 to 0.91) | <0.001 | 0.92 (0.89 to 0.96) | <0.001 | |
| HCV coded at DC admission | No | 795 (61) | 236 (58) | 1.06 (1.05 to 1.07) | <0.001 | 0.82 (0.79 to 0.86) | <0.001 | 0.87 (0.84 to 0.90) | <0.001 |
| Yes | 507 (39) | 168 (42) | 1.02 (1.01 to 1.03) | <0.001 | 0.96 (0.92 to 1.00) | 0.067 | 0.98 (0.94 to 1.02) | 0.342 | |
| DC diagnosis category* | Hepatic failure | 461 (35) | 147 (36) | 1.04 (1.03 to 1.05) | <0.001 | 0.88 (0.84 to 0.93) | <0.001 | 0.92 (0.88 to 0.96) | <0.001 |
| Ascites | 690 (53) | 207 (51) | 1.05 (1.04 to 1.06) | <0.001 | 0.87 (0.84 to 0.91) | <0.001 | 0.91 (0.88 to 0.94) | <0.001 | |
| Bleeding varices | 151 (12) | 50 (12) | 1.04 (1.02 to 1.05) | <0.001 | 0.89 (0.81 to 0.97) | 0.006 | 0.92 (0.85 to 0.99) | 0.03 | |
| HCC at time of DC admission | No | 1204 (92) | 352 (87) | 1.04 (1.04 to 1.05) | <0.001 | 0.87 (0.84 to 0.90) | <0.001 | 0.91 (0.88 to 0.93) | <0.001 |
| Yes | 98 (8) | 52 (13) | 1.07 (1.04 to 1.10) | <0.001 | 0.91 (0.83 to 0.99) | 0.028 | 0.97 (0.90 to 1.04) | 0.39 | |
| Chronic HCV status at time of DC | Chronic | 1220 (94) | 304 (75) | 1.04 (1.03 to 1.05) | <0.001 | 0.84 (0.81 to 0.87) | <0.001 | 0.88 (0.85 to 0.90) | <0.001 |
| Cleared | 82 (6) | 100 (25) | 1.07 (1.03 to 1.10) | <0.001 | 1.02 (0.94 to 1.11) | 0.58 | 1.09 (1.03 to 1.16) | 0.003 | |
*DC diagnosis category was defined using a hierarchy of ICD-10 codes, ranked in order of hepatic failure, ascites and then bleeding varices.
DAA, direct-acting antiviral; DC, decompensated cirrhosis; HCC, hepatocellular carcinoma; ICD, International Classification of Diseases; RR, relative risk; SVR, sustained viral response.