Risk of end‐stage liver disease, hepatocellular carcinoma, and liver‐related death by fibrosis stage in the hepatitis C Alaska Cohort
| Autor: | Youssef Barbour, Michael G. Bruce, Julia Plotnik, Brian J. McMahon, Dana J. T. Bruden, Annette Hewitt, Chriss Homan, Brenna C. Simons, Prabhu Gounder, Jim Gove, Susan McArdle, Philip R. Spradling, Lisa Townshend-Bulson |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Carcinoma Hepatocellular Cirrhosis Databases Factual Comorbidity Gastroenterology Article Cohort Studies End Stage Liver Disease Young Adult 03 medical and health sciences Liver disease 0302 clinical medicine Fibrosis Cause of Death Internal medicine Confidence Intervals Humans Medicine 030212 general & internal medicine Prospective cohort study Aged Proportional Hazards Models Retrospective Studies Hepatology medicine.diagnostic_test business.industry Biopsy Needle Liver Neoplasms Hepatitis C Hepatitis C Chronic Middle Aged medicine.disease Immunohistochemistry Survival Analysis digestive system diseases Hepatocellular carcinoma Liver biopsy Disease Progression Female 030211 gastroenterology & hepatology business Alaska |
| Zdroj: | Hepatology. 66:37-45 |
| ISSN: | 1527-3350 0270-9139 |
| Popis: | Long-term prospective studies of the outcomes associated with hepatitis C virus (HCV) infection are rare and critical for assessing the potential impact of HCV treatment. Using liver biopsy as a starting point, we analyzed the development of end-stage liver disease (ESLD), hepatocellular carcinoma (HCC), and liver-related death (LRD) according to fibrosis stage among a cohort of American Indian/Alaska Native persons in Alaska. Persons were classified as having no/mild (Ishak = 0,1), moderate (Ishak = 2), or severe (Ishak = 3,4) fibrosis or cirrhosis (Ishak = 5,6). We examined time until development of ESLD, HCC, and LRD and report survival probabilities at 3, 5, 7, and 10 years. Of 407 persons, 39% (n = 150) had no/mild fibrosis, 32% (n = 131) had moderate fibrosis, 22% (n = 88) had severe fibrosis, and 9% (n = 38) had cirrhosis. The average time of follow-up was 7.3 years. Within 5 years of biopsy, 1.7% (95% confidence interval [CI]: 0.4-6.8) of persons with no/mild fibrosis developed ESLD compared with 7.9% (95% CI, 4.0-15.2), 16.4% (95% CI, 9.6-27.2), and 49.0% (95% CI, 33.0-67.7) with moderate, severe fibrosis, and cirrhosis, respectively (P < 0.01). The 5-year outcome of HCC was 1.0% (95% CI, 0.1-7.0), 1.0% (95% CI, 0.1-6.6), 1.1% (95% CI, 0.2-7.7), and 13.4% (95% CI, 4.4-36.7) among persons with no/mild fibrosis, moderate fibrosis, severe fibrosis, and cirrhosis, respectively (P < 0.01). Five years after biopsy, 0.0% (95% CI, 0.0-14.8) of persons with no/mild fibrosis had suffered an LRD compared with 1.0% (95% CI, 0.2-7.5) of persons with moderate fibrosis, 4.7% (95% CI, 1.5-14.1) with severe fibrosis, and 16.3% (95% CI, 7.0-35.1) with cirrhosis (P < 0.01). Conclusion: For prevention of HCC, LRD, and ESLD in the short term, HCV therapy should target individuals who have more than mild fibrosis. (Hepatology 2017;66:37–45). |
| Databáze: | OpenAIRE |
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