title: All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus.
abstract: BACKGROUND
  A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in "real world" settings are important to assess the implications of delaying HCV treatment.
  
  
  METHODS
  This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation.
  
  
  RESULTS
  Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0-F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma.
  
  
  CONCLUSIONS
  The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease.
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Fujie
authors.initials: F
authors.lastname: Xu
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Moorman
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Xin
authors.initials: X
authors.lastname: Tong
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Loralee B
authors.initials: LB
authors.lastname: Rupp
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Eyasu H
authors.initials: EH
authors.lastname: Teshale
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Spradling
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Boscarino
authors.affiliation: Kaiser Permanente Hawaii, Honolulu.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Trinacty
authors.affiliation: Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schmidt
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
authors.forename: Eyasu H
authors.initials: EH
authors.lastname: Teshale
authors.forename: Philip R
authors.initials: PR
authors.lastname: Spradling
authors.forename: Anne C
authors.initials: AC
authors.lastname: Moorman
authors.forename: Jim
authors.initials: J
authors.lastname: Xing
authors.forename: Xin
authors.initials: X
authors.lastname: Tong
authors.forename: Fujie
authors.initials: F
authors.lastname: Xu
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.forename: David R
authors.initials: DR
authors.lastname: Nerenz
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Loralee B
authors.initials: LB
authors.lastname: Rupp
authors.forename: Nonna
authors.initials: N
authors.lastname: Akkerman
authors.forename: Nancy
authors.initials: N
authors.lastname: Oja-Tebbe
authors.forename: Talan
authors.initials: T
authors.lastname: Zhang
authors.forename: Jia
authors.initials: J
authors.lastname: Li
authors.forename: Alexander
authors.initials: A
authors.lastname: Sitarik
authors.forename: Dana
authors.initials: D
authors.lastname: Larkin
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Boscarino
authors.forename: Zahra S
authors.initials: ZS
authors.lastname: Daar
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Curry
authors.forename: Robert E
authors.initials: RE
authors.lastname: Smith
authors.forename: Vinutha
authors.initials: V
authors.lastname: Vijayadeva
authors.forename: John V
authors.initials: JV
authors.lastname: Parker
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schmidt
authors.forename: Judy L
authors.initials: JL
authors.lastname: Donald
authors.forename: Erin M
authors.initials: EM
authors.lastname: Keast
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology; D017093:Liver Failure / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: cirrhosis; hepatic decompensation; hepatitis C; hepatocellular carcinoma; mortality