%0 Journal Article %A Adriaan J van der Meer %A Bettina E Hansen %A Giovanna Fattovich %A Jordan J Feld %A Heiner Wedemeyer %A Jean-François Dufour %A Frank Lammert %A Andres Duarte-Rojo %A Michael P Manns %A Donatella Ieluzzi %A Stefan Zeuzem %A W Peter Hofmann %A Robert J de Knegt %A Bart J Veldt %A Harry L A Janssen %T 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 %D 2015 %R 10.1136/gutjnl-2013-305357 %J Gut %P 322-331 %V 64 %N 2 %X 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. %U https://gut.bmj.com/content/gutjnl/64/2/322.full.pdf