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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