Objective The Child-Pugh-score and MELD-score are important predictors of mortality in patients with decompensated cirrhosis. Although the prognosis varies considerably among patients with well-compensated advanced liver disease due to hepatitis C virus (HCV) infection, reliable tools based on readily available clinical parameters to predict long-term outcome are lacking. Design Risk scores for mortality and for cirrhosis-related complications were constructed with Cox regression analysis in a derivation cohort and evaluated in a validation cohort, both including patients with chronic HCV infection and advanced fibrosis. Results In the derivation cohort, 100/405 patients died during a median 8.1(IQR 5.7-11.1) years of follow-up. Multivariate Cox analyses showed age (HR=1.06, 95%CI 1.04-1.09,p<0.001), male sex (HR=1.91, 95%CI 1.10-3.29,p=0.021), platelet count (HR=0.91, 95%CI 0.87-0.95,p<0.001) and log10AST/ALTratio (HR=1.30, 95%CI 1.12-1.51,p=0.001) were independently associated with mortality (C-statistic=0.78 [95%CI 0.72-0.83]). In the validation cohort 58/296 cirrhotic patients died during a median of 6.6(IQR 4.4-9.0) years. Among patients with estimated 5-year mortality risks <5%, 5-10% and >10%, the observed 5-year mortality rates in the derivation cohort and validation cohort were 0.9% (95%CI 0.0-2.7) and 2.6% (95%CI 0.0-6.1), 8.1% (95%CI 1.8-14.4) and 8.0% (95%CI 1.3-14.7), 21.8% (95%CI 13.2-30.4) and 20.9% (95%CI 13.6-28.1), respectively (C-statistic in validation cohort: 0.76 [95%CI 0.69-0.83]). The risk score for cirrhosis-related complications also incorporated HCV genotype (C-statistics: 0.80 (95%CI 0.76-0.83) in the derivation cohort and 0.74 (95%CI 0.68-0.79) in the validation cohort). Conclusion Prognosis of patients with chronic HCV infection and compensated advanced liver disease can be accurately assessed with risk scores including readily available objective clinical parameters.
Reliable prediction of clinical outcome in patients with chronic HCV infection and compensated advanced hepatic fibrosis: a validated model using objective and readily clinical parameters.
FATTOVICH, Giovanna;IELUZZI, Donatella;
2015-01-01
Abstract
Objective The Child-Pugh-score and MELD-score are important predictors of mortality in patients with decompensated cirrhosis. Although the prognosis varies considerably among patients with well-compensated advanced liver disease due to hepatitis C virus (HCV) infection, reliable tools based on readily available clinical parameters to predict long-term outcome are lacking. Design Risk scores for mortality and for cirrhosis-related complications were constructed with Cox regression analysis in a derivation cohort and evaluated in a validation cohort, both including patients with chronic HCV infection and advanced fibrosis. Results In the derivation cohort, 100/405 patients died during a median 8.1(IQR 5.7-11.1) years of follow-up. Multivariate Cox analyses showed age (HR=1.06, 95%CI 1.04-1.09,p<0.001), male sex (HR=1.91, 95%CI 1.10-3.29,p=0.021), platelet count (HR=0.91, 95%CI 0.87-0.95,p<0.001) and log10AST/ALTratio (HR=1.30, 95%CI 1.12-1.51,p=0.001) were independently associated with mortality (C-statistic=0.78 [95%CI 0.72-0.83]). In the validation cohort 58/296 cirrhotic patients died during a median of 6.6(IQR 4.4-9.0) years. Among patients with estimated 5-year mortality risks <5%, 5-10% and >10%, the observed 5-year mortality rates in the derivation cohort and validation cohort were 0.9% (95%CI 0.0-2.7) and 2.6% (95%CI 0.0-6.1), 8.1% (95%CI 1.8-14.4) and 8.0% (95%CI 1.3-14.7), 21.8% (95%CI 13.2-30.4) and 20.9% (95%CI 13.6-28.1), respectively (C-statistic in validation cohort: 0.76 [95%CI 0.69-0.83]). The risk score for cirrhosis-related complications also incorporated HCV genotype (C-statistics: 0.80 (95%CI 0.76-0.83) in the derivation cohort and 0.74 (95%CI 0.68-0.79) in the validation cohort). Conclusion Prognosis of patients with chronic HCV infection and compensated advanced liver disease can be accurately assessed with risk scores including readily available objective clinical parameters.
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