title: Severity of liver disease among chronic hepatitis C patients: an observational study of 4594 patients in five European countries.
abstract: OBJECTIVE
  Assessment of the severity of liver disease following infection with hepatitis C virus (HCV) is important in treatment selection and prognosis. As invasive liver biopsy procedures are regarded as the reference method to assess the stage of fibrosis, it is important to identify patient characteristics that are predictive of liver fibrosis severity. The aim of the study was to describe the distribution of liver severity scores, clinical characteristics, and physicians' assessment of fibrosis among HCV patients in five European countries.
  
  
  METHODS
  This cross-sectional study retrospectively reviewed the medical records of patients who were chronically infected with HCV in 2006. Patients managed for HCV at any of 60 sites in France, Germany, Italy, Spain, and the UK were included. Data collected included patient demographics and clinical characteristics. A combination of univariate and multivariate regression analyses were used to identify predictors of fibrosis severity and factors associated with undergoing biopsy.
  
  
  RESULTS
  Four thousand five hundred and ninety-four chronically infected HCV patients were included in this analysis. Management approaches differed between countries, with variations in biopsy use (59.3-18.4%) and preferred fibrosis scoring systems. Where histology results were available, 43.4%, 23.8%, and 32.9% had mild, moderate, and severe fibrosis, respectively. Factors associated with undergoing a biopsy included male gender and co-infection with hepatitis B virus. Chronic alcoholism, a lower first platelet count, and older age were predictors of increased liver fibrosis severity.
  
  
  CONCLUSIONS
  These data suggest that there are major differences in how specialists manage their HCV patients across five major European countries.
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, University Paris-Diderot and INSERM CRB3, Clichy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
authors.forename: Kelly
authors.initials: K
authors.lastname: Grotzinger
authors.forename: Dickens
authors.initials: D
authors.lastname: Theodore
authors.forename: Dirk
authors.initials: D
authors.lastname: Demuth
authors.forename: Michael
authors.initials: M
authors.lastname: Manns
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares Cañizares
authors.forename: James
authors.initials: J
authors.lastname: Pike
authors.forename: Ulla M
authors.initials: UM
authors.lastname: Forssen
mesh_terms: D000328:Adult; D000437:Alcoholism; D001706:Biopsy / Q000706:statistics & numerical data; D060085:Coinfection; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005355:Fibrosis; D005544:Forecasting; D006505:Hepatitis; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D064887:Observational Studies as Topic; D010976:Platelet Count; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Europe; hepatitis C; liver fibrosis severity; observational study