The natural history of HCV-related cirrhosis and its temporal progression across the different clinical stages

Vilar‐Gomez, Eduardo; Bertot, Luis Calzadilla; Rodriguez, Yoan Sanchez; Gonzalez, Ana Torres; Pérez, Yadina Martínez; Garcia, A. Yasells

doi:10.1007/s12072-014-9565-1

Cited by 5 publications

(7 citation statements)

References 39 publications

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“…Cirrhosis of the liver is often not recognized until late in the disease state, due to the natural history of cirrhosis in which a long, compensated, asymptomatic phase is followed by progressively symptomatic decompensation phase. The decompensation phase is defined by the development of complications such as ascites, hepatic encephalopathy and bleeding esophageal varices [ 1 , 4 - 5 ]. Mean survival of patients with compensated cirrhosis is 10 - 12 years, with mortality occurring when patients pass into the decompensated phase of cirrhosis [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The decompensation phase is defined by the development of complications such as ascites, hepatic encephalopathy and bleeding esophageal varices [ 1 , 4 - 5 ]. Mean survival of patients with compensated cirrhosis is 10 - 12 years, with mortality occurring when patients pass into the decompensated phase of cirrhosis [ 5 ]. Cirrhosis is also a leading cause of hospitalizations with high costs, partly due to the late recognition of disease.…”

Section: Introductionmentioning

confidence: 99%

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Missed Diagnosis of Liver Cirrhosis Leads to Disparities in Care for Older Patients

2018

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BackgroundCirrhosis of the liver is often not recognized until late in the disease state, when patients decompensate or develop hepatocellular carcinoma (HCC). This inquiry considered factors associated with undiagnosed cirrhosis.MethodsPatients with undiagnosed cirrhosis were compared to patients with known diagnosis of cirrhosis, to evaluate the differences between these two groups. The study population is patients with confirmed diagnosis of HCC, stratified into patients with known diagnosis of cirrhosis (n = 36) and patients without the known diagnosis of cirrhosis who have features of cirrhosis (n = 36).ResultsThere was no significant difference in insurance, gender, race, etiology of liver disease, presence of splenomegaly, model for end stage liver disease (MELD) score, fibrosis-4 index (FIB-4) or aspartate aminotransferase (AST) to platelet ratio index (APRI) scores between groups. However, the strongest predictor of the diagnosis of cirrhosis was age, with older patients being less likely to be diagnosed with cirrhosis (OR: 0.924, P = 0.012). Furthermore, tumor size in patients without known cirrhosis was larger than those diagnosed with cirrhosis (median: 4.9 cm versus 3.5 cm, P = 0.015). Of note, 50% of cases with cirrhosis were undiagnosed.ConclusionOlder age was the most significant predictor of the missed diagnosis of liver cirrhosis. This led to a larger tumor size at diagnosis, which may imply worse prognosis in these patients. Further evaluation of health disparities related to older age and outcomes of older patients with liver cirrhosis should guide the development of guidelines to prevent the missed diagnosis of cirrhosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Missed Diagnosis of Liver Cirrhosis Leads to Disparities in Care for Older Patients

2018

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“…More than 90% of HCV infection in Egypt is due to genotype 4 which is the most common genotype in the Middle East and Africa [3]. HCV is the most common cause of chronic hepatitis which progresses in most of the patients into cirrhosis, portal hypertension, hepatocellular failure and hepatocellular carcinoma, thus HCV is an important cause of liver transplantation [4] [5]. The first drug used for treatment of patients with chronic HCV genotype 4 was conventional interferon (IFN)-alpha monotherapy that showed poor rates of sustained viral response (SVR) [6], then ribavirin was added which led to slight improvement of the results [7].…”

Section: Introductionmentioning

confidence: 99%

A Real Life Study on Treatment of Egyptian Patients with HCV Genotype IV with Simeprevir and Sofosbuvir

Hanno¹,

Elwazzan²,

Ibrahim³

et al. 2016

Health

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Background and Aims: Treatment with a combination of the nucleotide polymerase inhibitor sofosbuvir and NS3A (non-structural protein 3A) protease inhibitor simeprevir resulted in high rates of sustained virological response in chronic hepatitis C Genotype 4. Methods: We conducted a real life study on Egyptian patients coming to tropical medicine department clinic at El Mery main university hospital from February 2015 to February 2016 for treatment naïve and treatment experienced patients with chronic HCV genotype 4, including cirrhotics and non cirrhotics. Naïve (cirrhotics and non cirrhotics) and relapsers (non cirrhotics) received nucleotide polymerase inhibitor sofosbuvir and NS3A inhibitor simeprevir once daily for 12 weeks and 24 weeks for relapser cirrhotic patients. The primary end point was a sustained virologic response at 12 weeks after end of treatment. An informed consent was obtained from each patient at the beginning of the study (Real life study: a study on Egyptian patients when the drug was available in the market). Results: 30 naïve patients with HCV genotype 4 and 20 relapsers (10 non cirrhotic and 10 cirrhotic patients) were enrolled. Patient inclusion criteria: Naïve patients are those who tested positive for HCV RNA by PCR and had no experience to HCV treatment; Relapsers are those who tested positive for HCV RNA by PCR and had a previous treatment for HCV. Cirrhosis was diagnosed on ultrasound basis. Mean age was 53.57 ± 10.682 years old in naïve patients and 48.30 ± 5.100 years old in relapsers. Median baseline HCV RNA was 360,069 IU/mL for naïve patients and 1,245,000 IU/mL for relapsers; using Fib4 20% of naïve patients were F3-F4, while 40% of relapsers were F3-F4. Degree of fibrosis was confirmed by fibrotest in relapsers. Upon treatment of patients with sofosbuvir and semiprevir once daily for 12 weeks and 24 weeks only to cirrhotic relapsers, end of treatment PCR was negative in 100% in all groups including cirrhotics and non cirrhotics. Primary end point (SVR 12) was achieved in 100% of all patients. Second end point (SVR 24) was achieved in 96.6% of naïve patients; SVR 24 for non-cirrhotic relapsers was achieved in 100% of patients and in 90% of cirrhotic relapsers. One patient had transient total bilirubin elevations without in-A. Hanno et al. 781 creased ALT (alanine aminotransferase) or AST (aspartate aminotransferase). One patient developed cutaneous rash. Conclusion: Once daily sofosbuvir and simeprevir for 12 weeks provided high rate of sustained virological response among treatment naïve and treatment experienced patients with HCV genotype IV.

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“…The recurrence of hepatic decompensation events and mortality were frequently observed after the first hepatic decompensation event. [34][35][36] Planas et al 30 reported that the cumulative hospitalization rates for any hepatic decompensation event after the first hepatic decompensation event at 1 year and 2 years were 45.1% and 60.6%, respectively. In the present study, the cumulative hospitalization rates for any hepatic decompensation event at 1 year and 2 years were 44.2% and 65.6%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Clinical course of hepatitis C virus‐positive patients with decompensated liver cirrhosis in the era of direct‐acting antiviral treatment

Maesaka

Sakamori

Yamada

et al. 2021

Hepatology Research

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Aim:The aim of the present study was to investigate the clinical course in hepatitis C virus (HCV)-positive patients with decompensated liver cirrhosis after directacting antivirals (DAAs) have been used for HCV infection.Methods: This multicenter study prospectively analyzed a registered cohort composed of 73 HCV-positive patients with decompensated cirrhosis who attended our 11 institutions between January 2018 and July 2018. Prognoses, including changes in the liver reserve, hepatocellular carcinoma (HCC), decompensation events, and survival, were analyzed up to July 2020, as was the initiation of DAA treatment.Results: Sixty-four (87.7%) and nine (12.3%) patients had Child-Pugh class (C-P) B and C at baseline, respectively. Within 2 years after enrollment, 17 patients (23.3%) received treatment with DAAs, and 31 patients (42.5%) developed uncontrolled HCC,

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The natural history of HCV-related cirrhosis and its temporal progression across the different clinical stages

Abstract: Among compensated patients, the presence of varices suggests a more accelerated course of the disease. Decompensated patients show the most severe clinical course, particularly in those with a combination of two or more clinical events.

Cited by 5 publications

References 39 publications

Missed Diagnosis of Liver Cirrhosis Leads to Disparities in Care for Older Patients

Missed Diagnosis of Liver Cirrhosis Leads to Disparities in Care for Older Patients

A Real Life Study on Treatment of Egyptian Patients with HCV Genotype IV with Simeprevir and Sofosbuvir

Clinical course of hepatitis C virus‐positive patients with decompensated liver cirrhosis in the era of direct‐acting antiviral treatment

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