Waiting Daas List Mortality Impact in HCV Cirrhotic Patients

Abstract

BACKGROUND: The infection for the hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality through its evolution to liver cirrhosis, end-stage liver complications and hepatocellular carcinoma. Currently, the new drugs for the HCV infection, based on direct antiviral agents, have changed the outcomes in this setting. OBJECTIVE: To assess death incidence, during the wait for the treatment with the new drugs, and to analyze which independent variable (age, sex, ascite, HDA, albumin, α-fetoprotein, platelets and Meld score) had relation with death. METHODS: Prospective study with cirrhotic patients by HCV. Inclusion: cirrhotic patients by hepatic biopsy (METAVIR), clinic or image, detectable RNA (HCV). Exclusion: Other stages of hepatic fibrosis and hepatocellular carcinoma. Descriptive statistic in continue variables. Fisher Exact and Kaplan Meier and Cox Regression Analysis to assess the association of variables studied with death. P<0.05. RESULTS: A total of 129 patients were included. Of this, 73% were men. Mean age was 57.8±12.1, albumin of 3.5±0.6 mg/dL, platelets of 123.4±59.6 and Meld score of 10.59±3.56. The time of observation was 11.2±3.26 months, and the number of death 9/129 (6,9%). The Kaplan-Meier showed association between death with albumin lower than 2.9 (0.0006), MELD score higher than 15 (0.007) and α-fetoprotein higher than 40 ng/mL (<0.0001). Adjusted Cox Regression Analysis showed that α-fetoprotein higher than 40 ng/ml could be considered an independent risk for death. CONCLUSION: We conclude that, patients with advanced cirrhosis should be prioritized for treatment with direct antiviral agents.

Chronic Hepatitis C Is Still a Problem for the Public Health Care System in Brazil

“…In this volume, Silva et al publish the article "Waiting DAAs list mortality impact in HCV cirrhotic patients" (6) . The authors have followed a cohort of 129 patients with HCV cirrhosis for 11.2 months while on a waiting list for treatment with DAAs.…”

Avaliação da imunogenicidade anti-HBV em portadores crônicos do vírus da hepatite C não cirróticos após exposição a dois esquemas de vacina contra hepatite B

“…A hepatite C ocorre em uma larga proporção de todos os casos de evolução grave e progressiva da doença, sendo comumente causa de descompensação de função hepática com aparecimento de ascite, encefalopatia e sangramento digestivo 4 , como complicações de hipertensão portal ou ainda uma das principais causas de tumor primário de fígado, o carcinoma hepatocelular (CHC) 5 .…”