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Prognosis of chronic hepatitis c: Results of a large, prospective cohort study
Author(s) -
Niederau Claus,
Lange Stefan,
Heintges Tobias,
Erhardt Andreas,
Buschkamp Marlies,
Hürter Dietmar,
Nawrocki Marek,
Kruska Lothar,
Hensel Frank,
Petry Wolfgang,
Häussinger Dieter
Publication year - 1998
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.510280632
Subject(s) - medicine , cirrhosis , gastroenterology , hepatocellular carcinoma , liver disease , liver transplantation , hepatitis c , prospective cohort study , chronic liver disease , hepatitis c virus , population , transplantation , immunology , virus , environmental health
The prognosis of chronic hepatitis C virus (HCV) infection is still ill‐defined. The present study prospectively evaluated mortality and complications in a large cohort of patients with chronic hepatitis C. The study included 838 anti‐HCV and HCV‐RNA–positive patients who were followed for 50.2 ± 26.9 months (mean ± SD; range, 6‐122 months) in a prospective protocol. During follow‐up, 62 patients died (31 from liver disease and 31 from other causes), and 12 patients needed liver transplantation. When compared with a matched general population, hepatitis C increased mortality mainly when cirrhosis was present and in patients who were less than 50 years old at study entry. During follow‐up, a further 30 patients developed nonlethal complications of cirrhosis. By multivariate regression, survival was decreased by cirrhosis, long disease duration, history of intravenous drug abuse, and excessive alcohol consumption, whereas interferon therapy improved survival. Alanine transaminase (ALT), bilirubin, sex, and genotype had no effect on survival. The risk of hepatocellular carcinoma (HCC) (n = 17) was increased by cirrhosis and to a lesser degree by long disease duration and high bilirubin, whereas interferon therapy, genotype, and other factors had no effect. Chronic hepatitis C is a disease with considerable mortality and morbidity when cirrhosis is present at diagnosis. Patients who acquire the infection early in life have a markedly increased mortality even when cirrhosis is absent at diagnosis. The age at diagnosis therefore should play a major role in therapeutic considerations. The present data also suggest that interferon therapy has a long‐term clinical benefit, although it did not reduce the risk of liver cancer.