title: Liver-specific case fatality due to chronic hepatitis C virus infection: a systematic review.
abstract: Despite reports that mortality is increasing, overall case fatality due to hepatitis C virus (HCV) is thought to be low. Given the variability in published rates, we aimed to synthesize estimates of liver-specific case fatality and all-cause mortality in chronic HCV according to follow-up duration, sustained viral response (SVR) to treatment, and liver disease severity. A systematic review was conducted of studies published in English from 2003 to 2013, reporting liver-specific case fatality estimates from HCV-infected samples. Thirty-five eligible articles were identified; 26 also presented estimates of all-cause mortality. Among community-based samples, liver-specific case fatality ranged from 0.3% over 5.7 years to 9.2% over 8.2 years of follow-up; and of all-cause mortality, from 4.0% over 5.7 years, to 23.0% over 8.2 years of follow-up. Estimates were higher among clinic-based samples and those with more severe liver disease. Among treated patients achieving SVR, liver-specific case fatality was low: up to 1.4% over 11.5 years of follow-up among samples with any severity of liver disease. Estimates were higher among those without SVR: up to 14.0% over 10 years of followup among samples with any severity of liver disease, and higher still among samples with more severe liver disease. The proportion of deaths attributable to liver-specific causes ranged from 55 to 85% among those with severe liver disease. Published estimates of fatality are high among certain populations of chronic HCV patients, with liver-specific causes being an important contributor. Understanding current HCV mortality rates is important for quantifying the total burden of HCV disease.
authors.affiliation: ICON Epidemiology, Vancouver BC Canada.
authors.forename: Shelagh M
authors.initials: SM
authors.lastname: Szabo
authors.affiliation: AbbVie Global Health Economics and Outcomes Research, Abbott Park, IL USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Samp
authors.affiliation: AbbVie Global Health Economics and Outcomes Research, Abbott Park, IL USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Walker
authors.affiliation: ICON Epidemiology, Vancouver BC Canada.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lane
authors.affiliation: AbbVie Global Health Economics and Outcomes Research, Abbott Park, IL USA.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Cline
authors.affiliation: AbbVie Global Health Economics and Outcomes Research, Abbott Park, IL USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Gooch
authors.affiliation: University of British Columbia, Vancouver BC Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Jimenez-Mendez
authors.affiliation: ICON Epidemiology, Vancouver BC Canada.
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Levy
mesh_terms: D002423:Cause of Death; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors