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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Article info
Publication history
Published online: October 29, 2012
Accepted:
October 16,
2012
Received in revised form:
October 14,
2012
Received:
May 11,
2012
Identification
Copyright
© 2012 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
