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Prediction of morbidity and mortality in patients with chronic hepatitis C by non‐invasive liver fibrosis models
Author(s) -
Chinnaratha Mohamed A.,
Jeffrey Gary P.,
MacQuillan Gerry,
Rossi Enrico,
Boer Bastiaan W.,
Speers David J.,
Adams Leon A.
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12306
Subject(s) - medicine , liver biopsy , decompensation , gastroenterology , liver transplantation , hazard ratio , liver disease , cirrhosis , biopsy , proportional hazards model , hepatitis c , transplantation , confidence interval
Abstract Background & Aims Liver fibrosis is prognostic of outcomes among patients with chronic hepatitis C ( CHC ). We evaluated the accuracy of non‐invasive markers and liver biopsy in predicting morbidity and mortality in CHC patients. Methods Compensated CHC patients were evaluated over a 10‐year period. Non‐invasive markers including Hepascore, FIB ‐4, APRI and liver biopsy results were retrospectively collated. Follow‐up morbidity and mortality data were obtained from the Western Australian Data Linkage System. The prognostic significance of baseline non‐invasive markers and biopsy were assessed using Kaplan–Meier analysis. Results A total of 406 subjects (64% male, mean age 48 ± 11 years) were followed up for 2385 person‐years, during which there were 22 (5.4%) deaths including 14 (3.4%) who died from liver disease or required liver transplantation. Sixteen (3.9%) subjects developed liver decompensation. Hepascore and liver biopsy ( P < 0.005) but not APRI or FIB ‐4 were predictive of overall and liver‐related mortality as well as liver decompensation. A Hepascore>0.5 was associated with increased overall mortality [Hazard Ratio (95% CI ) 6.7 (2.6–17), P < 0.001], liver‐related mortality [32.8 (4.3–250), P = 0.001] and risk of future decompensation [11.8 (3.3–41), P < 0.001], whereas a Hepascore ≤0.5 was associated with a 99% probability of not dying from liver‐related causes over 10 years. Hepascore had comparable accuracy with liver biopsy in predicting liver‐related mortality with AUROC of 0.86 (95% CI 0.80–0.90) and 0.87 (0.79–0.96), respectively. Conclusion Hepascore is predictive of overall and liver‐related mortality and morbidity in CHC patients with comparable accuracy to liver biopsy. Hepascore may be a useful prognostic marker in clinical practice.