TY - JOUR
T1 - Predicting mortality risk in patients with compensated HCV-induced cirrhosis
T2 - 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
PY - 2009/5
Y1 - 2009/5
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 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 10 at study entry had a prolonged life expectancy.
AB - 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 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 10 at study entry had a prolonged life expectancy.
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U2 - 10.1038/ajg.2009.31
DO - 10.1038/ajg.2009.31
M3 - Article
C2 - 19352340
AN - SCOPUS:66949112194
SN - 0002-9270
VL - 104
SP - 1147
EP - 1157
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 5
ER -