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Predicting mortality risk in patients with compensated HCV-induced cirrhosis: a long-term prospective study.
Am J Gastroenterol. 2009 May; 104(5):1147-58.AJ

Abstract

OBJECTIVES

The identification of prognostic factors associated with mortality is crucial in any clinical setting.

METHODS

We enrolled in a prospective study 352 patients with compensated hepatitis C virus (HCV)-induced cirrhosis, consecutively observed between 1989 and 1992. At entry, patients underwent upper endoscopy to detect esophageal varices, and were then surveilled by serial clinical and ultrasonographic examination. The model for end-stage liver disease (MELD) score was calculated with information collected at enrollment. Baseline predictors and intercurrent events associated with mortality were assessed using the Cox regression model.

RESULTS

During a median follow-up of 14.4 years, 194 subjects received a single course of interferon monotherapy, 131 patients developed decompensation (ascites, bleeding, hepatic encephalopathy), 109 patients had hepatocellular carcinoma (HCC), 9 had liver transplant, and 158 died. Esophageal varices were associated with development of decompensation (hazard ratio (HR), 2.09; 95% confidence interval (CI), 1.33-3.30) and liver-related death (HR, 2.27; 95% CI, 1.41-3.66). A MELD score of > 10 predicted overall mortality (HR, 2.15; 95% CI, 1.50-3.09). Overall survival of patients with MELD < or = 10 was 80% at 10 years. HCC occurrence increased the risk of decompensation fivefold (HR, 5.52; 95% CI, 3.77-8.09). Hepatic and overall mortality hazard ratios were 8.62 (95% CI, 5.57-13.3) and 3.80 (95% CI, 2.67-5.42), respectively, for patients who developed HCC, and 16.9 (95% CI, 9.97-28.6) and 7.08 (95% CI, 4.88-10.2) for those who experienced decompensation.

CONCLUSIONS

In patients with compensated HCV-induced cirrhosis, the presence of esophageal varices at baseline predicted decompensation and mortality. The development of HCC during follow-up strongly hastens the occurrence of decompensation, which is the main determinant of death. Patients with a MELD score < or = 10 at study entry had a prolonged life expectancy.

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Authors+Show Affiliations

Bruno S
Department of Internal Medicine, AO Fatebenefratelli e Oftalmico, Milan, Italy. savino.bruno@fbf.milano.it
Zuin M
No affiliation info available
Crosignani A
No affiliation info available
Rossi S
No affiliation info available
Zadra F
No affiliation info available
Roffi L
No affiliation info available
Borzio M
No affiliation info available
Redaelli A
No affiliation info available
Chiesa A
No affiliation info available
Silini EM
No affiliation info available
Almasio PL
No affiliation info available
Maisonneuve P
No affiliation info available

MeSH

AdultAgedAntiviral AgentsBiopsy, Fine-NeedleCause of DeathCohort StudiesConfidence IntervalsDisease ProgressionEsophageal and Gastric VaricesFemaleFollow-Up StudiesHepatitis C, ChronicHumansImmunohistochemistryInterferon-alphaKaplan-Meier EstimateLiver CirrhosisLiver FailureMaleMiddle AgedPredictive Value of TestsProbabilityProportional Hazards ModelsProspective StudiesRisk AssessmentSeverity of Illness IndexSurvival AnalysisTime Factors

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19352340

Citation

Bruno, Savino, et al. "Predicting Mortality Risk in Patients With Compensated HCV-induced Cirrhosis: a Long-term Prospective Study." The American Journal of Gastroenterology, vol. 104, no. 5, 2009, pp. 1147-58.
Bruno S, Zuin M, Crosignani A, et al. Predicting mortality risk in patients with compensated HCV-induced cirrhosis: a long-term prospective study. Am J Gastroenterol. 2009;104(5):1147-58.
Bruno, S., Zuin, M., Crosignani, A., Rossi, S., Zadra, F., Roffi, L., Borzio, M., Redaelli, A., Chiesa, A., Silini, E. M., Almasio, P. L., & Maisonneuve, P. (2009). Predicting mortality risk in patients with compensated HCV-induced cirrhosis: a long-term prospective study. The American Journal of Gastroenterology, 104(5), 1147-58. https://doi.org/10.1038/ajg.2009.31
Bruno S, et al. Predicting Mortality Risk in Patients With Compensated HCV-induced Cirrhosis: a Long-term Prospective Study. Am J Gastroenterol. 2009;104(5):1147-58. PubMed PMID: 19352340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting mortality risk in patients with compensated HCV-induced cirrhosis: a long-term prospective study. AU - Bruno,Savino, AU - Zuin,Massimo, AU - Crosignani,Andrea, AU - Rossi,Sonia, AU - Zadra,Felice, AU - Roffi,Luigi, AU - Borzio,Mauro, AU - Redaelli,Alessandro, AU - Chiesa,Alberto, AU - Silini,Enrico Maria, AU - Almasio,Piero Luigi, AU - Maisonneuve,Patrick, Y1 - 2009/04/07/ PY - 2009/4/9/entrez PY - 2009/4/9/pubmed PY - 2009/6/16/medline SP - 1147 EP - 58 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 104 IS - 5 N2 - OBJECTIVES: The identification of prognostic factors associated with mortality is crucial in any clinical setting. METHODS: We enrolled in a prospective study 352 patients with compensated hepatitis C virus (HCV)-induced cirrhosis, consecutively observed between 1989 and 1992. At entry, patients underwent upper endoscopy to detect esophageal varices, and were then surveilled by serial clinical and ultrasonographic examination. The model for end-stage liver disease (MELD) score was calculated with information collected at enrollment. Baseline predictors and intercurrent events associated with mortality were assessed using the Cox regression model. RESULTS: During a median follow-up of 14.4 years, 194 subjects received a single course of interferon monotherapy, 131 patients developed decompensation (ascites, bleeding, hepatic encephalopathy), 109 patients had hepatocellular carcinoma (HCC), 9 had liver transplant, and 158 died. Esophageal varices were associated with development of decompensation (hazard ratio (HR), 2.09; 95% confidence interval (CI), 1.33-3.30) and liver-related death (HR, 2.27; 95% CI, 1.41-3.66). A MELD score of > 10 predicted overall mortality (HR, 2.15; 95% CI, 1.50-3.09). Overall survival of patients with MELD < or = 10 was 80% at 10 years. HCC occurrence increased the risk of decompensation fivefold (HR, 5.52; 95% CI, 3.77-8.09). Hepatic and overall mortality hazard ratios were 8.62 (95% CI, 5.57-13.3) and 3.80 (95% CI, 2.67-5.42), respectively, for patients who developed HCC, and 16.9 (95% CI, 9.97-28.6) and 7.08 (95% CI, 4.88-10.2) for those who experienced decompensation. CONCLUSIONS: In patients with compensated HCV-induced cirrhosis, the presence of esophageal varices at baseline predicted decompensation and mortality. The development of HCC during follow-up strongly hastens the occurrence of decompensation, which is the main determinant of death. Patients with a MELD score < or = 10 at study entry had a prolonged life expectancy. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/19352340/Predicting_mortality_risk_in_patients_with_compensated_HCV_induced_cirrhosis:_a_long_term_prospective_study_ L2 - https://Insights.ovid.com/pubmed?pmid=19352340 DB - PRIME DP - Unbound Medicine ER -