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Published on: July 16, 2012
WAITING DAAS LIST MORTALITY IMPACT IN HCV CIRRHOTIC PATIENTS
Giovanni Faria Silva1, Vanessa Gutierrez de Andrade1, Alecsandro Moreira1
1Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Clínica Médica, Botucatu, SP, Brasil.
Insights
Hepatitis C virus (HCV) patients with advanced cirrhosis face higher mortality risks. Prioritizing treatment for those with low albumin, high MELD scores, or elevated alpha-fetoprotein can improve outcomes.
Area of Science:
- Hepatology and Viral Hepatitis Research
- Clinical Medicine and Patient Outcomes
- Liver Disease Epidemiology
Background:
- Hepatitis C virus (HCV) infection is a major cause of liver disease, cirrhosis, and liver cancer.
- Direct antiviral agents have transformed HCV treatment outcomes.
- Understanding mortality risk during treatment waitlists is crucial.
Purpose of the Study:
- To determine death incidence in HCV patients awaiting direct antiviral agent therapy.
- To identify independent predictors of mortality, including age, sex, ascites, albumin, alpha-fetoprotein, platelets, and MELD score.
Main Methods:
- Prospective study of 129 HCV cirrhotic patients.
- Inclusion criteria: biopsy-confirmed cirrhosis, detectable HCV RNA. Exclusion: other liver fibrosis stages, hepatocellular carcinoma.
- Statistical analysis included Kaplan-Meier and Cox Regression.
Main Results:
- A 6.9% mortality rate (9/129 patients) was observed during the study period.
- Lower albumin (<2.9 mg/dL), higher MELD score (>15), and higher alpha-fetoprotein (>40 ng/mL) were associated with increased death risk.
- Elevated alpha-fetoprotein (>40 ng/mL) emerged as an independent predictor of mortality.
Conclusions:
- Patients with advanced cirrhosis and specific biomarkers indicating high risk should be prioritized for direct antiviral agent treatment.
- Early intervention is critical for improving survival in HCV-infected individuals with advanced liver disease.
Background:
The infection for the hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality through its evolution to liver cirrhosis, end-stage liver complications and hepatocellular carcinoma. Currently, the new drugs for the HCV infection, based on direct antiviral agents, have changed the outcomes in this setting.
Objective:
To assess death incidence, during the wait for the treatment with the new drugs, and to analyze which independent variable (age, sex, ascite, HDA, albumin, α-fetoprotein, platelets and Meld score) had relation with death.
Methods:
Prospective study with cirrhotic patients by HCV. Inclusion: cirrhotic patients by hepatic biopsy (METAVIR), clinic or image, detectable RNA (HCV). Exclusion: Other stages of hepatic fibrosis and hepatocellular carcinoma. Descriptive statistic in continue variables. Fisher Exact and Kaplan Meier and Cox Regression Analysis to assess the association of variables studied with death. P<0.05.
Results:
A total of 129 patients were included. Of this, 73% were men. Mean age was 57.8±12.1, albumin of 3.5±0.6 mg/dL, platelets of 123.4±59.6 and Meld score of 10.59±3.56. The time of observation was 11.2±3.26 months, and the number of death 9/129 (6,9%). The Kaplan-Meier showed association between death with albumin lower than 2.9 (0.0006), MELD score higher than 15 (0.007) and α-fetoprotein higher than 40 ng/mL (<0.0001). Adjusted Cox Regression Analysis showed that α-fetoprotein higher than 40 ng/ml could be considered an independent risk for death.
Conclusion:
We conclude that, patients with advanced cirrhosis should be prioritized for treatment with direct antiviral agents.
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