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Original article
Reliable prediction of clinical outcome in patients with chronic HCV infection and compensated advanced hepatic fibrosis: a validated model using objective and readily available clinical parameters
  1. Adriaan J van der Meer1,
  2. Bettina E Hansen1,
  3. Giovanna Fattovich2,
  4. Jordan J Feld3,
  5. Heiner Wedemeyer4,
  6. Jean-François Dufour5,
  7. Frank Lammert6,
  8. Andres Duarte-Rojo3,
  9. Michael P Manns4,
  10. Donatella Ieluzzi7,
  11. Stefan Zeuzem8,
  12. W Peter Hofmann8,
  13. Robert J de Knegt1,
  14. Bart J Veldt1,
  15. Harry L A Janssen1,3
  1. 1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Medicine, University of Verona, Verona, Italy
  3. 3Liver Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  4. 4Departments of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
  5. 5Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
  6. 6Department of Medicine II, Saarland University Medical Center, Homburg, Germany
  7. 7Department of Surgery, University of Verona, Verona, Italy
  8. 8Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
  1. Correspondence to Adriaan J van der Meer, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Gravendijkwal 230, Room Ha 206, 3015 CE Rotterdam, The Netherlands; a.vandermeer{at}erasmusmc.nl

Abstract

Objective Reliable tools to predict long-term outcome among patients with well compensated advanced liver disease due to chronic HCV infection are lacking.

Design Risk scores for mortality and for cirrhosis-related complications were constructed with Cox regression analysis in a derivation cohort and evaluated in a validation cohort, both including patients with chronic HCV infection and advanced fibrosis.

Results In the derivation cohort, 100/405 patients died during a median 8.1 (IQR 5.7–11.1) years of follow-up. Multivariate Cox analyses showed age (HR=1.06, 95% CI 1.04 to 1.09, p<0.001), male sex (HR=1.91, 95% CI 1.10 to 3.29, p=0.021), platelet count (HR=0.91, 95% CI 0.87 to 0.95, p<0.001) and log10 aspartate aminotransferase/alanine aminotransferase ratio (HR=1.30, 95% CI 1.12 to 1.51, p=0.001) were independently associated with mortality (C statistic=0.78, 95% CI 0.72 to 0.83). In the validation cohort, 58/296 patients with cirrhosis died during a median of 6.6 (IQR 4.4–9.0) years. Among patients with estimated 5-year mortality risks <5%, 5–10% and >10%, the observed 5-year mortality rates in the derivation cohort and validation cohort were 0.9% (95% CI 0.0 to 2.7) and 2.6% (95% CI 0.0 to 6.1), 8.1% (95% CI 1.8 to 14.4) and 8.0% (95% CI 1.3 to 14.7), 21.8% (95% CI 13.2 to 30.4) and 20.9% (95% CI 13.6 to 28.1), respectively (C statistic in validation cohort = 0.76, 95% CI 0.69 to 0.83). The risk score for cirrhosis-related complications also incorporated HCV genotype (C statistic = 0.80, 95% CI 0.76 to 0.83 in the derivation cohort; and 0.74, 95% CI 0.68 to 0.79 in the validation cohort).

Conclusions Prognosis of patients with chronic HCV infection and compensated advanced liver disease can be accurately assessed with risk scores including readily available objective clinical parameters.

  • HEPATITIS C
  • CIRRHOSIS

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