Natarajan Yamini, White Donna L, El-Serag Hashem B, Ramsey David, Richardson Peter, Kuzniarek Jill, Shukla Richa, Tansel Aylin, Kanwal Fasiha
Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
Dig Dis Sci. 2017 Jan;62(1):76-83. doi: 10.1007/s10620-016-4303-2. Epub 2016 Sep 21.
Medical comorbidities and functional status limitations are determinants of mortality in many chronic diseases. The extent to which survival in the rapidly aging cohort of patients with HCV is affected by these competing causes of mortality remains unclear.
We sought to determine the effect of medical/functional comorbidities on survival after adjusting for liver disease severity in a cohort of patients with HCV infection.
We prospectively recruited consecutive patients from an HCV clinic 2009-2014. We calculated an index of survival (Schonberg Index, SI) based on age, gender, medical comorbidities, and functional status variables. We defined cirrhosis with the FibroSure test (F3/4-F4). We used multivariable Cox modeling to assess association between functional/survival measure and survival after adjustment for severity of liver disease.
The cohort consisted of 1052 HCV patients. The average age was 56.8 years; 36 % had cirrhosis. The mean SI was 8.2 (SD = 2.7). During a mean follow-up of 5610 person-years, 102 (9.7 %) patients died. In unadjusted analysis, higher baseline SI predicted mortality (HR 1.17; 95 % CI 1.09-1.25). SI similarly predicted mortality in cirrhotic patients (HR 1.23, 95 % CI 1.13-1.34) and non-cirrhotic patients (HR 1.21, 95 % CI 1.08-1.36). This did not change after adjusting for age, drug use, or coronary artery disease.
Comorbidities and functional limitations predict higher mortality in patients with HCV; this relationship is independent of cirrhosis. Use of general prognostic indices may help identify HCV patients at high risk for mortality, which could further guide clinical care in a manner not achievable with assessment of liver disease alone.
合并症和功能状态受限是许多慢性疾病死亡率的决定因素。在丙型肝炎病毒（HCV）感染患者快速老龄化的队列中，这些相互竞争的死亡原因对生存的影响程度尚不清楚。
我们试图确定在调整丙型肝炎病毒感染患者队列中肝病严重程度后，合并症/功能合并症对生存的影响。
我们在2009年至2014年期间从一家丙型肝炎诊所前瞻性地招募了连续的患者。我们根据年龄、性别、合并症和功能状态变量计算了一个生存指数（舍恩伯格指数，SI）。我们使用FibroSure检测（F3/4 - F4）定义肝硬化。我们使用多变量Cox模型评估在调整肝病严重程度后功能/生存指标与生存之间的关联。
该队列由1052例丙型肝炎患者组成。平均年龄为56.8岁；36%患有肝硬化。平均SI为8.2（标准差 = 2.7）。在平均5610人年的随访期间，102例（9.7%）患者死亡。在未调整分析中，较高的基线SI预测死亡率（风险比1.17；95%置信区间1.09 - 1.25）。SI在肝硬化患者（风险比1.23，95%置信区间1.13 - 1.34）和非肝硬化患者（风险比1.21，95%置信区间1.08 - 1.36）中同样预测死亡率。在调整年龄、药物使用或冠状动脉疾病后，这一情况没有改变。
合并症和功能受限预示着丙型肝炎患者的死亡率更高；这种关系独立于肝硬化。使用一般的预后指数可能有助于识别丙型肝炎高死亡风险患者，这可以以一种仅评估肝病无法实现的方式进一步指导临床护理。
