Hospitalisations With Cryoglobulin-Related Diseases in Spain Over 25 Years.

in Liver international : official journal of the International Association for the Study of the Liver by Mario Martín-Portugués, Jorge Esteban-Sampedro, Carmen de Mendoza, Guillermo Ruiz-Irastorza, Ana Royuela, Alfonso Ortega-de la Puente, Marina de la Cruz-Echeandía, Xiomara Patricia Blanco-Valencia, Vicente Soriano, Víctor Moreno-Torres

TLDR

  • The study found that hospitalization rates for patients with cryoglobulinemia decreased in Spain after the introduction of DAAs for HCV treatment, likely due to a reduction in HCV prevalence rates. The proportion of cases associated with HBV, hematological, and autoimmune diseases increased over the study period.

Abstract

The epidemiology of cryoglobulinemia in Spain has likely changed following the widespread adoption of direct-acting antivirals (DAAs) since 2015 for the treatment of hepatitis C virus (HCV) infection, the principal cause of mixed cryoglobulinemia (MC). All hospital admissions of patients with cryoglobulinemic disease at the National Registry of Hospital Discharges were retrospectively examined in Spain from 1997 to 2022. The following primary conditions associated with cryoglobulinemia were considered: chronic viral infections, haematological diseases (HD), and autoimmune diseases (AD). A total of 16 929 admissions for patients with cryoglobulinemic disease were recorded during the study period. Hospitalisation rates for patients with cryoglobulinemia steadily increased from 1997 to 2015 (from 10.8 to 17.9 admissions per 1 million habitants, APC = +2.1), and decreased from 2018 to 2022 (from 15.7 to 11 admissions per 1 million habitants, APC = -7) (p < 0.001 for all). The drastic changes in HCV prevalence rates determined this shift (26.3% in 1997, 52.7% in 2016 and 27.9% in 2022, p < 0.001). The proportion of patients with cryoglobulinemia associated with hepatitis B virus (HBV), paraproteinemias, non-Hodgkin lymphoma, systemic lupus erythematosus, primary Sjögren syndrome and rheumatoid arthritis steadily increased during the study period as cause of hospitalisation in patients with cryoglobulinemia (from 1997 to 2022, p < 0.001), while human immunodeficiency virus infection remained fairly stable since 2005. The introduction of DAA as treatment for HCV has resulted in a significant reduction in hospitalisations due to cryoglobulinemia in Spain. As a result, cases due to HBV, hematologic and autoimmune diseases have emerged as conditions of growing importance associated with cryoglobulinemia hospitalisations.

Overview

  • The study analyzed hospital admissions for patients with cryoglobulinemic disease in Spain from 1997 to 2022 to examine the impact of direct-acting antivirals (DAAs) on the epidemiology of cryoglobulinemia.
  • The study found that hospitalization rates for patients with cryoglobulinemia increased from 1997 to 2015, but decreased from 2018 to 2022, likely due to a reduction in hepatitis C virus (HCV) prevalence rates.
  • The study aimed to identify the primary conditions associated with cryoglobulinemia, including chronic viral infections, hematological diseases, and autoimmune diseases.

Comparative Analysis & Findings

  • The study found that hospitalization rates for patients with cryoglobulinemia increased significantly from 10.8 to 17.9 admissions per 1 million habitants from 1997 to 2015, representing a 2.1% annual percentage change (APC).
  • However, hospitalization rates decreased significantly from 15.7 to 11 admissions per 1 million habitants from 2018 to 2022, representing a 7% APC.
  • The proportion of patients with cryoglobulinemia associated with hepatitis B virus (HBV), paraproteinemias, non-Hodgkin lymphoma, systemic lupus erythematosus, primary Sjögren syndrome, and rheumatoid arthritis increased significantly over the study period.

Implications and Future Directions

  • The study suggests that the widespread adoption of DAAs for HCV treatment has led to a significant reduction in hospitalizations due to cryoglobulinemia in Spain.
  • Future research could investigate the impact of DAAs on the epidemiology of cryoglobulinemia in other countries and explore the growing importance of cases associated with HBV, hematological and autoimmune diseases.
  • The study highlights the need for ongoing surveillance and monitoring of cryoglobulinemia to better understand its changing epidemiology and to identify emerging trends and associations.
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