Liver steatosis is a major predictor of poor outcomes in chronic hepatitis C patients with sustained virological response
Autor: | Marius Braun, Alon Barsheshet, Assaf Issachar, Yael Harif, Michal Cohen-Naftaly, Moshe Leshno, Amir Shlomai, Noam Peleg, Evelin Oxtrud, Orly Sneh Arbib |
---|---|
Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
Carcinoma Hepatocellular Multivariate analysis Cirrhosis Sustained Virologic Response Kaplan-Meier Estimate Antiviral Agents Gastroenterology 03 medical and health sciences 0302 clinical medicine Liver steatosis Cause of Death Virology Statistical significance Internal medicine medicine Humans Public Health Surveillance 030212 general & internal medicine Propensity Score Hepatology business.industry Incidence Incidence (epidemiology) Liver Neoplasms Hepatitis C Chronic Prognosis medicine.disease digestive system diseases Fatty Liver Patient Outcome Assessment Infectious Diseases Hepatocellular carcinoma 030211 gastroenterology & hepatology Metabolic syndrome business Transient elastography Follow-Up Studies |
Zdroj: | Journal of Viral Hepatitis. 26:1257-1265 |
ISSN: | 1365-2893 1352-0504 |
Popis: | Sustained virological response (SVR) results in reduced incidence of hepatocellular carcinoma (HCC) and mortality among chronic hepatitis C (CHC) patients with advanced fibrosis. Since both advanced fibrosis and liver steatosis (LS) may coexist in CHC patients, we evaluated their individual effects on a composite outcome of all-cause mortality and HCC in CHC patients with SVR following direct-acting antivirals (DAA) treatment. We retrospectively evaluated inception cohort of 515 CHC patients who achieved SVR following treatment with DAA, with a mean follow-up of 24 months. Baseline liver fibrosis was assessed by transient elastography, and LS was validated by at least three independent ultrasonographic examinations. 211 of 515 patients (41%) had baseline LS. Patients with LS had a higher cumulative rate of all-cause mortality and HCC at 2 years of follow-up compared to patients without LS (15.75% and 2.79%, respectively, P < 0.001), although they did not have increased incidence of advanced fibrosis or cirrhosis. Consistently, multivariate analysis showed that LS was associated with a significant 7.5-fold increased risk of all-cause mortality and HCC (HR 7.51, 95% C.I 3.61-13.36, P < 0.001) even upon adjustment to components of the metabolic syndrome, whereas advanced fibrosis showed only a trend towards statistical significance (HR 2.32, 95% C.I 0.97-6.59, P = 0.06). In conclusion, LS is a major predictor of all-cause mortality and HCC in patients who achieved SVR following DAA treatment regardless of fibrosis stage. These patients should be rigorously screened for HCC. |
Databáze: | OpenAIRE |
Externí odkaz: | |
Nepřihlášeným uživatelům se plný text nezobrazuje | K zobrazení výsledku je třeba se přihlásit. |