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Chronic hepatitis: disease factors at diagnosis predictive of mortality
B A Lashner1, R B Jonas, H S Tang
1Liver Study Unit, University of Chicago Medical Center, Illinois 60637.
Insights
Identifying prognostic factors for chronic hepatitis mortality is crucial. A depressed aminopyrine breath test (ABT) and specific clinical indicators predict increased risk in patients with chronic hepatitis.
Area of Science:
- Hepatology
- Internal Medicine
- Clinical Pathology
Background:
- Chronic hepatitis carries significant mortality.
- Accurate prognostic assessment is vital for patient management.
Purpose of the Study:
- To identify prognostic factors for mortality in chronic hepatitis patients.
- To evaluate the additional prognostic value of the aminopyrine breath test (ABT).
Main Methods:
- 94 patients with biopsy-proven chronic hepatitis and ABT were studied.
- Clinical, biochemical, and histologic data were analyzed.
- Cox proportional hazards model used to identify mortality predictors.
Main Results:
- Histologic severity, hepatitis B virus, high alkaline phosphatase, low alanine aminotransaminase, and depressed ABT predicted mortality.
- Mortality rates increased with disease severity (cirrhosis: 53%).
Conclusions:
- Patients with identified risk factors require close monitoring for liver failure.
- Early intervention may be necessary for high-risk chronic hepatitis patients.
Purpose:
Chronic hepatitis is known to be a disease with substantial mortality. The purpose of this study was to identify prognostic factors in a large group of patients with chronic hepatitis. We also wanted to determine whether the aminopyrine breath test (ABT) is of additional prognostic value in evaluation of this disease.
Patients And Methods:
We studied 94 patients who had had a biopsy-proven diagnosis and an ABT between June 1, 1977, and June 30, 1981. Clinical features and biochemical test results at the time of diagnosis were retrieved from medical records, and histologic severity was assessed by reviewing all liver biopsy specimens under code. Survival was determined at a mean of 60 months. Data were studied with a Cox proportional hazards model to identify predictors of mortality and to control for confounding variables.
Results:
Cumulative mortality as of December 31, 1985, was 5 percent in chronic persistent hepatitis, 6 percent in chronic active hepatitis, 29 percent in chronic active hepatitis with bridging necrosis, and 53 percent in chronic active hepatitis with cirrhosis. Histologic severity was a predictor of death (p less than 0.005). Other predictors of mortality were disease caused by hepatitis B virus (p less than 0.005), a high alkaline phosphatase level (p less than 0.025), a low alanine aminotransaminase level (p less than 0.001), and a depressed ABT result (p less than 0.005).
Conclusion:
The results suggest that patients with chronic hepatitis with one or more of these risk factors have an increased mortality and should be followed closely for liver failure, which may necessitate medical therapy or surgical intervention.