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Prognosis of chronic hepatitis C: results of a large, prospective cohort study
C Niederau1, S Lange, T Heintges
1Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany. claus.niederau@uni-duesseldorf.de
Insights
Chronic hepatitis C (HCV) significantly increases mortality, especially with cirrhosis or early-life infection. Interferon therapy may improve survival but does not prevent liver cancer.
Area of Science:
- Hepatology
- Virology
- Clinical Medicine
Background:
- Prognosis of chronic hepatitis C virus (HCV) infection remains unclear.
- Chronic HCV poses significant mortality and morbidity risks, particularly with advanced liver disease.
Purpose of the Study:
- To prospectively evaluate mortality and complications in a large cohort of chronic hepatitis C patients.
- To identify factors influencing survival and hepatocellular carcinoma (HCC) risk in chronic HCV.
Main Methods:
- Prospective follow-up of 838 anti-HCV and HCV-RNA-positive patients for a mean of 50.2 months.
- Multivariate regression analysis to determine predictors of survival and HCC risk.
- Comparison of mortality rates with a matched general population.
Main Results:
- HCV infection increased mortality, primarily in patients with cirrhosis or those under 50 at diagnosis.
- Cirrhosis, long disease duration, IV drug abuse, and alcohol use decreased survival.
- Interferon therapy was associated with improved survival but not reduced HCC risk.
- HCC risk was elevated by cirrhosis, long disease duration, and high bilirubin levels.
Conclusions:
- Chronic hepatitis C is associated with substantial mortality and morbidity, particularly when cirrhosis is present.
- Early age at diagnosis significantly increases mortality risk, even without cirrhosis.
- Interferon therapy demonstrates long-term survival benefits in chronic HCV patients.
Abstract:
The prognosis of chronic hepatitis C virus (HCV) infection is still ill-defined. The present study prospectively evaluated mortality and complications in a large cohort of patients with chronic hepatitis C. The study included 838 anti-HCV and HCV-RNA-positive patients who were followed for 50.2 +/- 26.9 months (mean +/- SD; range, 6-122 months) in a prospective protocol. During follow-up, 62 patients died (31 from liver disease and 31 from other causes), and 12 patients needed liver transplantation. When compared with a matched general population, hepatitis C increased mortality mainly when cirrhosis was present and in patients who were less than 50 years old at study entry. During follow-up, a further 30 patients developed nonlethal complications of cirrhosis. By multivariate regression, survival was decreased by cirrhosis, long disease duration, history of intravenous drug abuse, and excessive alcohol consumption, whereas interferon therapy improved survival. Alanine transaminase (ALT), bilirubin, sex, and genotype had no effect on survival. The risk of hepatocellular carcinoma (HCC) (n = 17) was increased by cirrhosis and to a lesser degree by long disease duration and high bilirubin, whereas interferon therapy, genotype, and other factors had no effect. Chronic hepatitis C is a disease with considerable mortality and morbidity when cirrhosis is present at diagnosis. Patients who acquire the infection early in life have a markedly increased mortality even when cirrhosis is absent at diagnosis. The age at diagnosis therefore should play a major role in therapeutic considerations. The present data also suggest that interferon therapy has a long-term clinical benefit, although it did not reduce the risk of liver cancer.