Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
Henry Ford Health System, Detroit, Michigan.
Clin Infect Dis. 2016 Feb 1;62(3):289-297. doi: 10.1093/cid/civ860. Epub 2015 Sep 28.
A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in "real world" settings are important to assess the implications of delaying HCV treatment.
This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation.
Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0-F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma.
The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease.
慢性丙型肝炎病毒 (HCV) 感染患者护理的一个关键问题是立即开始治疗还是延迟治疗。在“真实世界”环境中，死亡率和疾病进展的风险对于评估延迟 HCV 治疗的影响很重要。
这是一项在美国 4 个综合医疗系统中确定的 HCV 患者队列研究，这些患者在 2001 年至 2012 年期间进行了肝活检。通过活检在观察开始时确定的纤维化阶段（Metavir F0-F4），估计了 1、2 或 5 年内死亡和进展为肝细胞癌、肝失代偿（肝性脑病、食管静脉曲张、腹水或门静脉高压）或肝移植的概率。
在 2799 例 HCV 单感染患者中，有资格进行肝活检，活检时的平均年龄为 50.7 岁。大多数是男性（58.9%）和非西班牙裔白人（66.9%）。在平均观察 5.0 年后，261 例（9.3%）患者死亡，34 例（1.2%）接受了肝移植。在活检后 5 年，F4 期患者进展为肝失代偿或肝细胞癌的估计风险为 37.2%，F3 期为 19.6%，F2 期为 4.7%，F0-F1 期为 2.3%。基线活检 F3 或 F4 期和血小板计数低于正常是进展为肝失代偿或肝细胞癌的最强预测因素。
死亡和进展为肝功能衰竭的风险因纤维化阶段而异。临床医生和政策制定者可以在优先排序和确定早期肝病患者的治疗时机时使用这些进展风险数据。
