title: Role of Non-hepatic Medical Comorbidity and Functional Limitations in Predicting Mortality in Patients with HCV.
abstract: Medical comorbidities and functional status limitations are determinants of mortality in many chronic diseases. The extent to which survival in the rapidly aging cohort of patients with HCV is affected by these competing causes of mortality remains unclear.
  
  
  
  We sought to determine the effect of medical/functional comorbidities on survival after adjusting for liver disease severity in a cohort of patients with HCV infection.
  
  
  
  We prospectively recruited consecutive patients from an HCV clinic 2009-2014. We calculated an index of survival (Schonberg Index, SI) based on age, gender, medical comorbidities, and functional status variables. We defined cirrhosis with the FibroSure test (F3/4-F4). We used multivariable Cox modeling to assess association between functional/survival measure and survival after adjustment for severity of liver disease.
  
  
  
  The cohort consisted of 1052 HCV patients. The average age was 56.8 years; 36 % had cirrhosis. The mean SI was 8.2 (SD = 2.7). During a mean follow-up of 5610 person-years, 102 (9.7 %) patients died. In unadjusted analysis, higher baseline SI predicted mortality (HR 1.17; 95 % CI 1.09-1.25). SI similarly predicted mortality in cirrhotic patients (HR 1.23, 95 % CI 1.13-1.34) and non-cirrhotic patients (HR 1.21, 95 % CI 1.08-1.36). This did not change after adjusting for age, drug use, or coronary artery disease.
  
  
  
  Comorbidities and functional limitations predict higher mortality in patients with HCV; this relationship is independent of cirrhosis. Use of general prognostic indices may help identify HCV patients at high risk for mortality, which could further guide clinical care in a manner not achievable with assessment of liver disease alone.
authors.affiliation: Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA. Yamini.Natarajan@va.gov.
authors.forename: Yamini
authors.initials: Y
authors.lastname: Natarajan
authors.affiliation: Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.|Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.|Texas Medical Center Digestive Disease Center, Houston, TX, USA.|Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, USA.|Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Donna L
authors.initials: DL
authors.lastname: White
authors.affiliation: Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.|Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.|Texas Medical Center Digestive Disease Center, Houston, TX, USA.|Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, USA.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.affiliation: Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ramsey
authors.affiliation: Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.affiliation: Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Kuzniarek
authors.affiliation: Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Richa
authors.initials: R
authors.lastname: Shukla
authors.affiliation: Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Aylin
authors.initials: A
authors.lastname: Tansel
authors.affiliation: Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.|Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.|Texas Medical Center Digestive Disease Center, Houston, TX, USA.|Dan L. Duncan Cancer Center at Baylor College of Medicine, Houston, TX, USA.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D058625:End Stage Liver Disease; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: Comorbidity; Epidemiology; Hepatitis C; Hepatology; Mortality; Natural history; Prognosis