The Long–Term Outcomes of Patients With Compensated Hepatitis C Virus-Related Cirrhosis and History of Parenteral Exposure in the United States

Abstract

It is well known that hepatitis C virus (HCV) infection may progress to cirrhosis and is linked to the development of hepatocellular carcinoma (HCC). Previous studies haveshown that compensated HCV-cirrhosis is related to a certain morbidity and mortality in European patients, but little is known in regard to the clinical outcomes of a similar group of patients in the United States. This study investigated this category of patients in terms of the incidence of decompensation, development of HCC, mortality, and the predictive risk factors for morbidity and mortality. The potential effects of interferon (IFN) therapy on outcomes of the disease also were assessed. A total of 112 patients with compensated HCV-cirrhosis and a documented history of either intravenous drug abuse (IVDA) or transfusion were consecutively enrolled. The mean follow-up interval was 4.5 (2-7.7) years. The cumulative probabilities for decompensation and development of HCC were 22.2% and 10.1% in 5 years, with an estimated yearly incidence of 4.4% and 2.0%, respectively. The cumulative survival probability was 82.8% from entry and 51.1% from decompensation in 5 years, with estimated yearly events of mortality and liver transplantation of 3.4% and 9.8%, respectively. It was found that age at entry and initial exposure, initial levels of albumin, platelet count, and prothrombin time (PT) were predictive risk factors for developing decompensation, whereas age at entry and initial exposure, history of transfusion, lower initial levels of albumin, platelet count, and viral load were predictive risk factors for events of mortality and liver transplantation. The incidence of decompensation was significantly lower in patients treated with IFN, but age may have played a contributory role. In contrast, neither HCC development nor mortality was significantly altered by IFN therapy. In conclusion, our study indicated that patients with compensated HCVcirrhosis in the United States progressed slowly and experienced eventual morbidity and mortality. Once decompensation develops, the disease will be more progressive and result in even higher mortality. Further studies will be required to determine the efficacy of IFN on clinical outcomes in this group of patients. (HEPATOLOGY 1999;29: 1311-1316.)

Which patients with hepatitis C develop liver complications?

“…[13][14][15][16]19,21,22 Several au- thors have found a low incidence of life-threatening events and liver-related deaths during the second decade of HCV infection. 8,11,12,17,29 In the present study, the likely time of HCV acquisition was known for only 38% of those who developed liver-related complications.…”

“…[18][19][20][21] Once cirrhosis has developed, the rate of liver-related complications including HCC and liver-related death is 18% to 31% during 5-year followup. [13][14][15][16]22 However, the personal, viral and disease-related factors that influence the development of such events remain contentious or poorly documented.The aims of the present study were to analyze hepatic complications and survival in a cohort of patients with chronic hepatitis C that was unusually diverse in age, country of birth, HCV genotype, risk factor for HCV, and histological stage of hepatic fibrosis. We determined the rate of all major liver complications, including liver failure, liver transplantation, HCC, and liver-related death, as well as death from other causes.…”

“…[18][19][20][21] Once cirrhosis has developed, the rate of liver-related complications including HCC and liver-related death is 18% to 31% during 5-year followup. [13][14][15][16]22 However, the personal, viral and disease-related factors that influence the development of such events remain contentious or poorly documented.…”

“…Many studies are confined to either the first 20 years of HCV infection when complications appear to be unusual, [8][9][10][11][12][13][14][15] or to the late stage of the disease when cirrhosis is present. [13][14][15][16] Thus some cohort studies have found low mortality rates at 17 to 20 years, particularly among younger individuals and among those who have a risk factor other than blood transfusion. 8,9,11,12,17 Others have indicated that approximately 18% of patients develop liver-related complications or HCC or succumb to liver-related death within 18 years of acquiring HCV from blood transfusion.…”

“Silent killer” or benign disease? The dilemma of hepatitis C virus outcomes

“…8 Perhaps the inability to ascertain a risk factor for exposure to HCV is indicative of longer duration of infection, which is believed to correlate with more advanced disease and complications. 3,6,9 Alternatively, because almost all sporadic cases noted in the present study were of non-native (i.e., non-Australian/New Zealand) ethnicity, it is conceivable that this population differs from the Australian/New Zealand population in having one or more host factors, yet to be identified, that confer increased risk of hepatic decompensation. Because the majority of natural history studies have been conducted in Northern European, predominantly white populations, ethnicity as a variable associated with disease progression has been inadequately addressed.…”