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All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected

Fujie Xu1, Anne C Moorman1, Xin Tong1

  • 1Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|September 30, 2015
PubMed

Insights

Delaying hepatitis C virus (HCV) treatment increases risks of death and liver disease progression, especially in advanced fibrosis stages. These findings aid clinicians in timing treatment for HCV patients.

Area of Science:

  • Hepatology
  • Viral Hepatitis
  • Clinical Epidemiology

Background:

  • Chronic hepatitis C virus (HCV) infection management involves deciding when to initiate treatment.
  • Assessing real-world risks of mortality and disease progression is crucial for understanding the implications of delayed HCV treatment.

Purpose of the Study:

  • To estimate the risks of mortality and liver disease progression in HCV-monoinfected patients based on fibrosis stage.
  • To inform clinical and policy decisions regarding the timing of HCV treatment.

Main Methods:

  • A cohort study of 2799 HCV patients with liver biopsies from 2001-2012 across four US health systems.
  • Probabilities of death, hepatocellular carcinoma, hepatic decompensation, or liver transplant were estimated over 1, 2, and 5 years, stratified by Metavir fibrosis stage (F0-F4).

Main Results:

  • Over a mean of 5.0 years, 9.3% of patients died and 1.2% received liver transplants.
  • At 5 years post-biopsy, estimated progression risks to hepatic decompensation or hepatocellular carcinoma were 37.2% (F4), 19.6% (F3), 4.7% (F2), and 2.3% (F0-F1).
  • Advanced fibrosis (F3-F4) and low platelet count were key predictors of disease progression.

Conclusions:

  • Significant variation in death and liver failure progression risks exists based on fibrosis stage.
  • These data can guide clinicians and policymakers in prioritizing and timing treatment for patients with early-stage liver disease.
Abstract

Keywords:
cirrhosishepatic decompensationhepatitis Chepatocellular carcinomamortality

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