title: The natural history of hepatitis C with severe hepatic fibrosis.
abstract: OBJECTIVE
  To examine the morbidity and mortality of patients with severe fibrosis secondary to HCV infection, within a population unbiased by tertiary referral.
  
  
  METHODS
  One hundred and fifty HCV infected patients were identified from the Trent HCV study with a liver biopsy taken before 2002 demonstrating severe fibrosis (Ishak stage > or =4). Follow-up data were extracted from the database and hospital records.
  
  
  RESULTS
  Median follow-up was 51 months. Of the 131 patients with no prior history of decompensation, 33 (25%) died (n=25) or were transplanted (n=8), after a median interval of 42 months. The probability of survival without liver transplantation was 97%, 88%, and 78% at 1, 3, and 5 years, respectively. Hepatocellular carcinoma and/or decompensation was diagnosed in 33 (25%), after a median interval of 41 months. In multivariate analysis, combination antiviral therapy was associated with improved survival. Prognosis was not affected by the Ishak stage at index biopsy. There was a worse prognosis for the 19 patients with previous decompensation; 17 (89%) having either died (n=15) or been transplanted (n=2).
  
  
  CONCLUSIONS
  This study demonstrates that severe liver fibrosis (Ishak stage > or = 4) secondary to hepatitis C is associated with a poor prognosis, that may be improved following combination antiviral treatment.
authors.affiliation: Wolfson Digestive Disease Foundation, University Hospital, Queens Medical Centre, Nottingham, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Lawson
authors.forename: Simone
authors.initials: S
authors.lastname: Hagan
authors.forename: Kara
authors.initials: K
authors.lastname: Rye
authors.forename: Nader
authors.initials: N
authors.lastname: Taguri
authors.forename: Sonia
authors.initials: S
authors.lastname: Ratib
authors.forename: Abed M
authors.initials: AM
authors.lastname: Zaitoun
authors.forename: Keith R
authors.initials: KR
authors.lastname: Neal
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Ryder
authors.forename: William L
authors.initials: WL
authors.lastname: Irving
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents