All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus
| Autor: | Fujie, Xu, Anne C, Moorman, Xin, Tong, Stuart C, Gordon, Loralee B, Rupp, Mei, Lu, Eyasu H, Teshale, Philip R, Spradling, Joseph A, Boscarino, Connie M, Trinacty, Mark A, Schmidt, Scott D, Holmberg, Jim, Xing, David R, Nerenz, Lois, Lamerato, Yan, Wang, Nonna, Akkerman, Nancy, Oja-Tebbe, Talan, Zhang, Jia, Li, Alexander, Sitarik, Dana, Larkin, Zahra S, Daar, Patrick J, Curry, Robert E, Smith, Vinutha, Vijayadeva, John V, Parker, Judy L, Donald, Erin M, Keast |
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| Rok vydání: | 2015 |
| Předmět: |
Microbiology (medical)
Adult Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Carcinoma Hepatocellular medicine.medical_treatment Biopsy Liver transplantation Gastroenterology Risk Assessment Severity of Illness Index Cohort Studies 03 medical and health sciences Liver disease Young Adult 0302 clinical medicine Internal medicine medicine Carcinoma Humans 030212 general & internal medicine Hepatic encephalopathy Aged medicine.diagnostic_test business.industry Hepatitis C Hepatitis C Chronic Middle Aged medicine.disease Survival Analysis United States Infectious Diseases Liver biopsy Hepatocellular carcinoma Disease Progression 030211 gastroenterology & hepatology Female business Liver Failure |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 62(3) |
| ISSN: | 1537-6591 2001-2012 |
| Popis: | Background A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in "real world" settings are important to assess the implications of delaying HCV treatment. Methods This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation. Results Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0-F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma. Conclusions The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease. |
| Databáze: | OpenAIRE |
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