Prognostic factors in patients with hepatitis C virus infection and systemic vasculitis
Benjamin Terrier1, Oren Semoun, David Saadoun
1Department of Internal Medicine, CNRS, UMR 7211, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, and Université Pierre et Marie Curie Paris 6, Paris, France.
Insights
Hepatitis C virus (HCV)-related vasculitis prognosis is impacted by severe liver fibrosis and vasculitis severity. Antiviral therapy improved outcomes, while immunosuppressants worsened them in this study.
Area of Science:
- Hepatology
- Rheumatology
- Virology
Background:
- Hepatitis C virus (HCV)-related systemic vasculitis poses significant health risks.
- Previous prognostic studies predate modern antiviral therapies.
- This study focuses on a homogeneous patient group during the antiviral therapy era.
Purpose of the Study:
- To identify clinical, biologic, and therapeutic factors influencing prognosis in HCV-related systemic vasculitis.
- To analyze outcomes in patients treated during the antiviral therapy era.
Main Methods:
- Prospective follow-up of 151 HCV RNA-positive vasculitis patients (1993-2009).
- Analysis of clinical, biologic, and therapeutic factors for survival.
- Utilized the Five-Factors Score (FFS) for vasculitis severity assessment.
Main Results:
- 32% mortality over a median 54-month follow-up, primarily from infection and liver disease.
- Key poor prognostic factors included severe liver fibrosis, CNS, kidney, and heart involvement.
- PEGylated interferon plus ribavirin improved prognosis (HR 0.34), while immunosuppressants worsened it (HR 4.05).
Conclusions:
- Severe liver fibrosis and vasculitis severity are primary prognostic indicators at diagnosis.
- Antiviral agents are associated with favorable outcomes.
- Immunosuppressant treatment negatively impacts prognosis in HCV-related vasculitis.
Objective:
Hepatitis C virus (HCV)-related systemic vasculitis can cause significant morbidity and mortality. Most studies of the prognosis of patients with HCV-related systemic vasculitis are based on heterogeneous studies performed before the era of antiviral therapy. The aim of this study was to analyze the clinical, biologic, and therapeutic factors associated with prognosis in a homogeneous series of patients with HCV-related systemic vasculitis who were followed up during the era of antiviral therapy.
Methods:
One hundred fifty-one consecutive HCV RNA-positive patients with vasculitis were prospectively followed up between 1993 and 2009 and were analyzed for clinical, biologic, and therapeutic factors associated with survival.
Results:
After a median followup period of 54 months, 32 patients (21%) had died, mainly of infection and end-stage liver disease. The 1-year, 3-year, 5-year, and 10-year survival rates were 96%, 86%, 75%, and 63%, respectively. Baseline factors associated with a poor prognosis were the presence of severe liver fibrosis (hazard ratio [HR] 5.31), central nervous system involvement (HR 2.74), kidney involvement (HR 1.91), and heart involvement (HR 4.2). The Five-Factors Score (FFS), a vasculitis scoring system, was significantly associated with outcome. In multivariate analysis, severe fibrosis (HR 10.8) and the FFS (HR 2.49) were significantly associated with a poor prognosis. Treatment with the combination of PEGylated interferon plus ribavirin was associated with a good prognosis (HR 0.34), whereas treatment with immunosuppressive agents was associated with a poor outcome, after adjustment for the severity of vasculitis (HR 4.05). Among patients without severe fibrosis, the FFS was a good predictor of outcome, while among those with severe fibrosis, the severity of vasculitis had no prognostic value.
Conclusion:
At the time of the diagnosis of HCV-related systemic vasculitis, severe liver fibrosis and the severity of vasculitis were the main prognostic factors. Use of antiviral agents was associated with a good prognosis, whereas treatment with immunosuppressant agents had a negative impact.
Related Concept Videos
01:25Hepatitis
01:24Cirrhosis II: Pathophysiology
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:28Viral Hepatitis I: Introduction
01:26Nephrotic Syndrome II : Assessment and Medical Management
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not related to...