Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA.
Hepatology. 2019 Feb;69(2):487-497. doi: 10.1002/hep.29408. Epub 2018 May 15.
The impact of sustained virologic response (SVR) on mortality after direct-acting antiviral treatment is not well documented. This study evaluated the impact of direct-acting antiviral-induced SVR on all-cause mortality and on incident hepatocellular carcinoma (HCC) in 15,059 hepatitis C virus-infected patients with advanced liver disease defined by a FIB-4 >3.25. Overall, 1,067 patients did not achieve SVR (no SVR) and 13,992 patients achieved SVR. In a mean follow-up period of approximately 1.6 years, 195 no SVR patients and 598 SVR patients died. Mortality rates were 12.3 deaths/100 patient years of follow-up for no SVR patients and 2.6 deaths/100 patient years for SVR patients, a 78.9% reduction (P < 0.001). Among patients without a prior diagnosis of HCC, 140 no SVR patients and 397 SVR patients were diagnosed with incident HCC. HCC rates were 11.5 HCCs/100 patient years for no SVR patients and 1.9 HCCs/100 patient years for SVR patients, an 83.5% reduction (P < 0.001). In multivariable Cox proportional hazard models controlling for baseline demographics, clinical characteristics, and comorbidities, SVR was independently associated with reduced risk of death compared to no SVR (hazard ratio, 0.26; 95% confidence interval, 0.22-0.31; P < 0.001). A history of decompensated liver disease (hazard ratio, 1.57; 95% confidence interval, 1.34-1.83; P < 0.001) and decreased albumin (hazard ratio, 2.70 per 1 g/dL decrease; 95% confidence interval, 2.38-3.12; P < 0.001) were independently associated with increased risk of death. Conclusion: Those achieving SVR after direct-acting antiviral treatment had significantly lower all-cause mortality and lower incident HCC rates than those who did not achieve SVR.
直接作用抗病毒治疗后持续病毒学应答（SVR）对死亡率的影响尚未得到充分证实。本研究评估了直接作用抗病毒诱导的 SVR 对 15059 例因纤维化-4 指数（FIB-4）>3.25 而患有晚期肝病的丙型肝炎病毒感染患者的全因死亡率和肝细胞癌（HCC）发生率的影响。总体而言，1067 例患者未达到 SVR（无 SVR），13992 例患者达到 SVR。在平均约 1.6 年的随访期间，195 例无 SVR 患者和 598 例 SVR 患者死亡。无 SVR 患者的死亡率为每 100 患者年 12.3 例死亡，SVR 患者的死亡率为每 100 患者年 2.6 例死亡，降低了 78.9%（P<0.001）。在没有 HCC 既往诊断的患者中，140 例无 SVR 患者和 397 例 SVR 患者被诊断患有 HCC 事件。无 SVR 患者的 HCC 发生率为每 100 患者年 11.5 例，SVR 患者的 HCC 发生率为每 100 患者年 1.9 例，降低了 83.5%（P<0.001）。在多变量 Cox 比例风险模型中，控制基线人口统计学、临床特征和合并症后，SVR 与无 SVR 相比，死亡风险降低独立相关（风险比，0.26；95%置信区间，0.22-0.31；P<0.001）。失代偿性肝病史（风险比，1.57；95%置信区间，1.34-1.83；P<0.001）和白蛋白降低（风险比，每降低 1 g/dL 增加 2.70；95%置信区间，2.38-3.12；P<0.001）与死亡风险增加独立相关。结论：直接作用抗病毒治疗后达到 SVR 的患者的全因死亡率和 HCC 发生率明显低于未达到 SVR 的患者。
