Introduction Fibrosis progression in chronic hepatitis C infection is variable. We need tools to identify those patients who will progress rapidly to offer individualised patient management. We aimed to determine the predictors of progression in an unselected cohort of patients with advanced fibrosis.
Methods The study cohort was derived from one centre of the Trent Study of Patients with Hepatitis C Virus Infection, a prospective natural history study commenced in 1991. Inclusion criteria were: a) liver biopsy before 2011 demonstrating advanced fibrosis (Ishak stage ≥3); b) no clinical outcome prior to biopsy; and c) patient did not achieve sustained viral response during follow-up. Sera collected within 6 months of the index biopsy were analysed for ELF. Biopsies were restaged using the Ishak system by one pathologist. Collagen quantification with image analysis was performed on biopsies stained with picrosirius red. A clinical outcome was defined as the first event of: ascites, encephalopathy, variceal haemorrhage, hepatocellular carcinoma, transplant or liver-related death.
Results 136 patients were identified and 87 had sera available for ELF. 29 (33.3%) patients progressed to a clinical outcome (median follow-up 7.2 years). ELF was significantly associated with progression to clinical outcomes in univariate analysis (HR 2.07 [95% CI: 1.54–2.76]; p < 0.001). In a multivariate model including liver function tests, Ishak stage and collagen quantification, only ALP and ELF remained statistically significant (ALP: HR 1.004 [95% CI: 1.001–1.007; p = 0.016], ELF: HR 1.968 [95% CI: 1.454–2.663; p < 0.001].
Conclusion Our data suggest that ELF could be used to stratify risk of subsequent progression to clinical outcomes in advanced fibrosis secondary to hepatitis C infection.
Disclosure of Interest None Declared.
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