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The natural history of compensated HCV-related cirrhosis: A prospective long-term study

Published:October 29, 2012DOI:https://doi.org/10.1016/j.jhep.2012.10.023

      Background & Aims

      The natural history of HCV-related compensated cirrhosis has been poorly investigated in Latin-American countries. Our study evaluated mortality and clinical outcomes in compensated cirrhotic patients followed for 6 years.

      Methods

      Four hundred and two patients with compensated HCV-related cirrhosis were prospectively recruited in a tertiary care academic center. At the time of admission, patients were stratified as compensated (absence [stage 1] or presence [stage 2] of esophageal varices) as defined by D’Amico et al. Subjects were followed to identify overall mortality or liver transplantation and clinical complication rates.

      Results

      Among 402 subjects, 294 were categorized as stage 1 and 108 as stage 2. Over a median of 176 weeks, 42 deaths occurred (10%), of which 30 were considered liver-related (7%) and 12 non-liver-related (3%); eight individuals (2%) underwent liver transplantation; 30 patients (7%) developed HCC, 67 individuals in stage 1 (22%) developed varices and any event of clinical decompensation occurred in 80 patients (20%). The 6-year cumulative overall mortality or liver transplantation was 15% and 45%, for stages 1 and 2, respectively (p <0.001). The cumulative 6-year HCC incidence was significantly higher among patients with varices (29%) than those without varices (9%), p <0.001. Similarly, the cumulative 6-year incidence of any clinical liver-related complication was higher in patients with stage 2 (66%) as compared to 26% in those with stage 1, respectively (p <0.001).

      Conclusions

      Our results indicate significant morbidity and mortality and clinical outcome rates in compensated cirrhotic patients with varices (stage 2).

      Abbreviations:

      HCV (chronic hepatitis C virus), HCC (hepatocellular carcinoma), OLT (orthotopic liver transplantation), IFN (interferon), HIV (human immunodeficiency virus), AFP (α-fetoprotein), SBP (spontaneous bacterial peritonitis), CP score (Child-Pugh score), SVR (sustained virological response), RNA (ribonucleic acid), PCR (polymerase chain reaction), IQR (interquartile range), CI (confidence interval), sHR (subhazard ratios), MELD (model for end-stage liver disease), SOC (standard of care), AST (aspartate aminotransferase), ALT (alanine aminotransferase), HALT-C (Hepatitis C Antiviral Long-term Treatment against Cirrhosis), Peg (peginterferon), Rib (ribavirin), BMI (body mass index), INR (international normalized ratio)

      Keywords

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