Care of the Cirrhotic Patient

Jafri, Syed Mohammed; Gordon, Stuart C.

doi:10.1016/j.idc.2012.08.009

Infectious Disease Clinics of North America

2012

DOI: 10.1016/j.idc.2012.08.009

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Care of the Cirrhotic Patient

Syed Mohammed Jafri¹,

Stuart C. Gordon²

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Cited by 4 publications

(1 citation statement)

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“…Patients with chronic hepatitis C virus (HCV) infection are at risk for progressive hepatic fibrosis and cirrhosis, leading to hepatic decompensation (ie, hepatic encephalopathy, esophageal varices, or ascites) and hepatocellular carcinoma (HCC) [1,2]. Decedents with HCV infection listed among causes of death on their death certificates died at an age >20 years younger than decedents without HCV infection [3,4].…”

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confidence: 99%

All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus

Xu¹,

Moorman²,

Tong³

et al. 2015

Clin Infect Dis.

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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.

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Care of the Cirrhotic Patient

Cited by 4 publications

References 114 publications

All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus

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