title: Prediction of morbidity and mortality in patients with chronic hepatitis C by non-invasive liver fibrosis models.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology/Hepatology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Chinnaratha
authors.forename: Gary P
authors.initials: GP
authors.lastname: Jeffrey
authors.forename: Gerry
authors.initials: G
authors.lastname: MacQuillan
authors.forename: Enrico
authors.initials: E
authors.lastname: Rossi
authors.forename: Bastiaan W
authors.initials: BW
authors.lastname: de Boer
authors.forename: David J
authors.initials: DJ
authors.lastname: Speers
authors.forename: Leon A
authors.initials: LA
authors.lastname: Adams
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000821:virology; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014904:Western Australia / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: Hepascore; non-invasive markers; prognosis