Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response
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Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response. / Hallager, Sofie; Ladelund, Steen; Christensen, Peer Brehm; Kjær, Mette; Roege, Birgit Thorup; Grønbæk, Karin Elmegaard; Belard, Erika; Barfod, Toke S.; Madsen, Lone Galmstrup; Gerstoft, Jan; Tarp, Britta; Krarup, Henrik Bygum; Weis, Nina.
I: Clinical Epidemiology, Bind 9, 10.2017, s. 501-516.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response
AU - Hallager, Sofie
AU - Ladelund, Steen
AU - Christensen, Peer Brehm
AU - Kjær, Mette
AU - Roege, Birgit Thorup
AU - Grønbæk, Karin Elmegaard
AU - Belard, Erika
AU - Barfod, Toke S.
AU - Madsen, Lone Galmstrup
AU - Gerstoft, Jan
AU - Tarp, Britta
AU - Krarup, Henrik Bygum
AU - Weis, Nina
PY - 2017/10
Y1 - 2017/10
N2 - Background: Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors. Materials and methods: Patients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013. Results: Of 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43-1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36-1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22-0.62) for HCC and 0.31 (95% CI 0.17-0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR. Conclusion: Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.
AB - Background: Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors. Materials and methods: Patients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013. Results: Of 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43-1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36-1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22-0.62) for HCC and 0.31 (95% CI 0.17-0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR. Conclusion: Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.
KW - Chronic hepatitis C
KW - Cirrhosis
KW - Cohort study
KW - Liver-related morbidity
KW - Sustained virologic response
U2 - 10.2147/CLEP.S132072
DO - 10.2147/CLEP.S132072
M3 - Journal article
C2 - 29123424
AN - SCOPUS:85035059744
VL - 9
SP - 501
EP - 516
JO - Clinical Epidemiology
JF - Clinical Epidemiology
SN - 1179-1349
ER -
ID: 189665570