Premium
Long‐term outcome of chronic hepatitis C in a population‐based cohort and impact of antiviral therapy: a propensity‐adjusted analysis
Author(s) -
Di Martino V.,
Crouzet J.,
Hillon P.,
Thévenot T.,
Minello A.,
Monnet E.
Publication year - 2011
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/j.1365-2893.2011.01476.x
Subject(s) - medicine , propensity score matching , outcome (game theory) , cohort , chronic hepatitis , population , term (time) , antiviral therapy , hepatitis c , cohort study , virology , environmental health , virus , physics , mathematics , mathematical economics , quantum mechanics
Summary. This population‐based study aimed to assess the determinants of the outcome of chronic hepatitis C with analysis of the impact of antiviral therapy with or without sustained virological response (SVR) on cirrhosis decompensation, hepatocellular carcinoma, liver‐related and non‐liver‐related mortality. A total of 1159 HCV‐positive patients newly detected between 1994 and 2001 were included. For each outcome, the prognostic effect of patients’ baseline characteristics was estimated by time‐dependent Cox models using age as the time‐scale and adjusting for treatment received during follow‐up. The impact of antiviral therapy was assessed by using a propensity score in a sample including 184 patients treated in the first 24 months following diagnosis who were matched to 184 untreated patients. At the end of a 59‐month median follow‐up, 100 cases of compensated disease, 58 liver cancer and 163 deaths (55 liver related) were recorded. The 5‐year rates of decompensated cirrhosis, hepatocellular carcinoma, liver‐related and non‐liver‐related death were 4.4%, 2.7%, 5.0% and 8.9%, respectively. Multivariate analyses identified two variables with pejorative influence: alcohol consumption (RR = 4.29 for CD; RR = 5.76 for HCC; RR = 6.69 for liver‐related death; P < 0.0001); HCV diagnosis unrelated to systematic screening (RR = 2.25 for CD; RR = 3.05 for HCC; RR = 4.31 for liver‐related death, P < 0.03). In the matched subset, no significant benefit of antiviral therapy was observed. Nevertheless, among the 144 patients who achieved SVR, no death was observed. This population‐based study showed substantial rates of decompensated cirrhosis, hepatocellular carcinoma and non‐liver‐related mortality. Alcohol consumption and absence of systematic screening were significant determinants of poor outcome, whereas treatment did not have significant influence.