Premium
Complications and competing risks of death in compensated viral cirrhosis (ANRS CO12 CirVir prospective cohort)
Author(s) -
Trinchet JeanClaude,
Bourcier Valérie,
Chaffaut Cendrine,
Ait Ahmed Mohand,
Allam Setty,
Marcellin Patrick,
Guyader Dominique,
Pol Stanislas,
Larrey Dominique,
De Lédinghen Victor,
Ouzan Denis,
Zoulim Fabien,
Roulot Dominique,
Tran Albert,
Bronowicki JeanPierre,
Zarski JeanPierre,
Goria Odile,
Calès Paul,
Péron JeanMarie,
Alric Laurent,
Bourlière Marc,
Mathurin Philippe,
Blanc JeanFrédéric,
Abergel Armand,
Serfaty Lawrence,
Mallat Ariane,
Grangé JeanDidier,
Buffet Catherine,
Bacq Yannick,
Wartelle Claire,
Dao Thông,
Benhamou Yves,
Pilette Christophe,
Silvain Christine,
Christidis Christos,
Capron Dominique,
Thiefin Gérard,
Hillaire Sophie,
Di Martino Vincent,
Nahon Pierre,
Chevret Sylvie
Publication year - 2015
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.27743
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , decompensation , gastroenterology , prospective cohort study , cohort , liver disease , hepatitis c virus , cumulative incidence , hepatitis c , incidence (geometry) , hepatitis b virus , virus , virology , physics , optics
Various critical events, liver related or not, occur in patients with compensated cirrhosis, but their respective burden remains to be prospectively assessed. The aim of this prospective cohort study involving 35 French centers was to capture the whole spectrum of complications occurring in compensated viral cirrhosis (VC) using competing risks analyses. Inclusion criteria were: histologically proven cirrhosis resulting from hepatitis C virus (HCV) or hepatitis B virus (HBV); Child‐Pugh A; and no previous hepatic complications. The cohort was considered as a multistate disease model, cumulative incidences (CumIs) of events were estimated in a competing risks framework. A total of 1,654 patients were enrolled from 2006 to 2012 (HCV, 1,308; HBV, 315; HCV‐HBV, 31). During a median follow‐up of 34 months, at least one liver nodule was detected in 271 patients, confirmed as hepatocellular carcinoma (HCC) in 128 (4‐year cumI: 10.5%) and cholangiocarcinoma in 3. HCC incidence was higher in HCV (4‐year cumI: 11.4% vs. 7.4%; P = 0.05). HCC fulfilled Milan criteria in 79.3%, leading to curative treatment in 70.4%. Liver decompensation occurred more frequently in HCV patients (4‐year cumI: 10.8% vs. 3.6%; P = 0.0004). Virological eradication/control was achieved in 34.1% of HCV and 88.6% of HBV patients and was associated with a marked decrease in HCC, decompensation, and bacterial infection incidences. Survival was shorter in HCV patients (4‐year cumI: 91.6% vs. 97.2%; P = 0.0002). Death (n = 102; missing data: 6) was attributed to liver disease in 48 (47%; liver cancer: n = 18; miscellaneous, n = 30) and extrahepatic causes in 48 (47%; bacterial infection: n = 13; extrahepatic cancers: n = 10; cardiovascular events: n = 5; miscellaneous, n = 20). Conclusion : After 3 years of follow‐up, extrahepatic events still explained half of deaths in patients with compensated VC. A strong decrease in complications was linked to virological eradication/control. (H epatology 2015;62:737–750)