All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus
Clinical Infectious Diseases February 1, 2016 V.62 N.3 P.289-297
Fujie Xu, Anne C. Moorman, Xin Tong, Stuart C. Gordon, Loralee B. Rupp, Mei Lu, Eyasu H. Teshale, Philip R. Spradling, Joseph A. Boscarino, Connie M. Trinacty, Mark A. Schmidt, and Scott D. Holmberg for the Chronic Hepatitis Cohort Study (CHeCS) Investigators
1Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
2Henry Ford Health System, Detroit, Michigan
3Geisinger Health System, Danville, Pennsylvania
4Kaiser Permanente Hawaii, Honolulu
5Kaiser Permanente Northwest, Portland, Oregon
Correspondence: F. Xu, Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-G-37, Atlanta, GA 30333 (firstname.lastname@example.org)
In a large cohort of persons infected with hepatitis C virus, mortality and progression risks varied greatly by biopsy-determined fibrosis stage. This study provided robust estimates for liver complications when hepatitis C treatment was delayed for up to 5 years.
A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in “real world” settings are important to assess the implications of delaying HCV treatment.
This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001–2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0–F4) determined by biopsy at beginning of observation.
Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0–F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma.
The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease.