Factors Associated with the Progression of Fibrosis on Liver Biopsy in Alaska Native and American Indian Persons with Chronic Hepatitis C

Livingston, Stephen; Deubner, Heike; Bruden, Dana; McMahon, Brian J.; Homan, Chriss; Townshend‐Bulson, Lisa; Bruce, Michael G.; Hennessy, Thomas W.; Williams, James L.; Gretch, David R.

doi:10.1155/2010/692036

Cited by 13 publications

(15 citation statements)

References 22 publications

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“…Our finding that HCV infection acquired through blood transfusion is associated with higher rates of cirrhosis is in agreement with earlier retrospective studies that reported more aggressive histological inflammatory activity and a higher risk of hepatic decompensation in patients with transfusion-acquired hepatitis C (31,32). Our observation that duration of infection is a significant risk factor for the development of cirrhosis as assessed by FIB-4 corroborates earlier reports that showed duration of infection to be an independent predictor of advanced fibrosis in hepatitis C-infected individuals (33,34). Our observation that the duration of infection is positively associated with a higher likelihood of FIB-4-indicated cirrhosis also suggests that the FIB-4 test is a reliable predictor of cirrhosis.…”

Section: Discussionsupporting

confidence: 92%

Prevalence of Cirrhosis in Hepatitis C Patients in the Chronic Hepatitis Cohort Study (CHeCS): A Retrospective and Prospective Observational Study

Gordon

Lamerato

Rupp

et al. 2015

American Journal of Gastroenterology

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OBJECTIVES The severity of liver disease in the hepatitis C virus (HCV)-infected population in the United States remains uncertain. We estimated the prevalence of cirrhosis in adults with chronic hepatitis C (CHC) using multiple parameters including liver biopsy, diagnosis/procedure codes, and a biomarker. METHODS Patients enrolled in the Chronic Hepatitis Cohort Study (CHeCS) who received health services during 2006–2010 were included. Cirrhosis was identified through liver biopsy reports, diagnosis/procedure codes for cirrhosis or hepatic decompensation, and Fibrosis-4 (FIB-4) scores ≥5.88. Demographic and clinical characteristics associated with cirrhosis were identified through multivariable logistic modeling. RESULTS Among 9,783 patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy identified cirrhosis in only 661 (7%) patients, whereas FIB-4 scores and diagnosis/procedure codes for cirrhosis and hepatic decompensation identified cirrhosis in 2,194 (22%), 557 (6%), and 482 (5%) patients, respectively. Among 661 patients with biopsy-confirmed cirrhosis, only 356 (54%) had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for cirrhosis. Older age, male gender, Asian race, Hispanic ethnicity, genotype 3 infection, HIV coinfection, diabetes, history of antiviral therapy, and history of alcohol abuse were independently associated with higher odds of cirrhosis (all, P <0.05). Conversely, private health insurance coverage, black race, and HCV genotype 2 were associated with lower odds of cirrhosis. CONCLUSIONS A high proportion of patients with biopsy-confirmed cirrhosis are not assigned ICD-9 codes for cirrhosis. Consequently, ICD-9 codes may not be reliable as the sole indicator of the prevalence of cirrhosis in cohort studies. Use of additional parameters suggests a fourfold higher prevalence of cirrhosis than is revealed by biopsy alone. These findings suggest that cirrhosis in CHC patients may be significantly underdocumented and underdiagnosed.

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Section: Discussionsupporting

confidence: 92%

Prevalence of Cirrhosis in Hepatitis C Patients in the Chronic Hepatitis Cohort Study (CHeCS): A Retrospective and Prospective Observational Study

Gordon

Lamerato

Rupp

et al. 2015

American Journal of Gastroenterology

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“…Four studies evaluating progression from compensated to decompensated cirrhosis reported an incidence between 13-40% over a range of follow-up of 2.3-14.4 years. 15, 24, 31, 34 No clear pattern was identified between length of follow-up or patient characteristics and rate of outcomes. Notably, the definition of decompensation varied across studies.…”

Section: Resultsmentioning

confidence: 99%

“…19, 31 Variables found to be independently predictive of histologic progression are listed in Tables 2 and 4. Among all the variables assessed, baseline steatosis was most consistently reported as independently predictive of subsequent fibrosis progression (significant on multivariate analysis in 6 of 21 studies) with an odds ratio (OR) [(95% confidence interval (CI)] of 4.8 (1.3-18.3) to 14.3 (2.1-111.1).…”

Section: Resultsmentioning

confidence: 99%

“…19, 31 The variables found to be independently predictive of clinical progression are listed in Tables 3 and 4 . Among the variables assessed, baseline platelet count was the most consistent independent predictor of clinical outcomes (significant on multivariate analysis in 6 of 13 studies) followed by age, baseline AST/ALT ratio, albumin and bilirubin (each significant in 4 studies).…”

Section: Resultsmentioning

confidence: 99%

“…31 Six studies on histologic progression included a small number of patients with advanced fibrosis or cirrhosis on initial biopsy who were not able to progress according to the author's definition. 1718, 25, 28, 33, 38 Two studies evaluated select cohorts (Levine et al evaluated untreated Irish women who acquired HCV infection during pregnancy only, and Livingston et al evaluated only treatment naïve Alaska Native and American Indian persons) and were scored as having limited representativeness.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review: identifying patients with chronic hepatitis C in need of early treatment and intensive monitoring – predictors and predictive models of disease progression

Konerman

Yapalı

Lok

2014

Aliment Pharmacol Ther

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Summary Background Advances in hepatitis C therapies have led to increasing numbers of patients seeking treatment. As a result, logistical and financial concerns regarding how treatment can be provided to all patients with chronic hepatitis C (CHC) have emerged. Aim The aim of this review was to evaluate predictors and predictive models of histologic progression and clinical outcomes for patients with CHC. Methods MEDLINE via PubMed, EMBASE, Web of Science and Scopus were searched for studies published between January 2003 and June 2014.Two authors independently reviewed articles to select eligible studies and performed data abstraction. Results Twenty-nine studies representing 5817 patients from 20 unique cohorts were included. The outcome incidence rates were widely variable: 16-61% during median follow-up of 2.5-10 years for fibrosis progression; 13-40% over 2.3-14.4 years for hepatic decompensation; and 8-47% over 3.9-14.4 years for overall mortality. Multivariate analyses showed that baseline steatosis and baseline fibrosis score were the most consistent predictors of fibrosis progression (significant in 6/21 and 5/21, studies, respectively) while baseline platelet count (significant in 6/13 studies), aspartate and alanine aminotransferase (AST/ALT) ratio, albumin, bilirubin, and age (each significant in 4/13 studies) were the most consistent predictors of clinical outcomes. Five studies developed predictive models but none were externally validated. Conclusions Our review identified the variables that most consistently predict outcomes of patients with CHC allowing the application of risk based approaches to identify patients in need of early treatment and intensive monitoring. This approach maximizes effective use of resources and costly new direct-acting antiviral agents.

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Alterations in NK Cell Phenotype in Relation to Liver Steatosis in Children with Chronic Hepatitis C

et al. 2013

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NK cells were found to play an important role in liver fibrosis, a process commonly seen in a chronic liver disease such as chronic hepatitis C (CHC). The aim of this study was to evaluate potential differences in relation to coexisting liver steatosis in children with chronic hepatitis C. The study group consisted of 31 children with chronic hepatitis, aged 7–18 years (mean = 15 ± 2 years). Blood samples were taken prior to liver biopsy. The METAVIR scale was used for histological evaluation. Peripheral lymphocytes were subjected to monoclonal antibodies to CD56 antigen, KIRs and NKG2D antigens. Cells were assayed by flow cytometry for the ratio of positive cells and mean fluorescence intensity (MFI). Results were evaluated regarding the presence of liver steatosis. Significantly higher mean AST activity as well as higher AST-to-platelets ratio index (APRI) was observed in a group of children with coexisting liver steatosis. These children had significantly higher MFI for CD158e and lower MFI for NKG2D. All CHC patients had significantly higher MFI for NKG2D than the controls. The proportion of cells with expression of CD158i, KIR2D and APRI was found independent predictors of liver steatosis in univariate analysis and body mass index in logistic regression. The expression of NK cell receptors is altered in coexisting steatosis that may influence long-term prognosis in CHC.

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Factors Associated with the Progression of Fibrosis on Liver Biopsy in Alaska Native and American Indian Persons with Chronic Hepatitis C

Abstract: The presence of type 2 diabetes mellitus, steatosis and duration of HCV infection were independent predictors of advanced fibrosis in the present cohort, with significant fibrosis progression demonstrated in persons who underwent serial biopsies.

Cited by 13 publications

References 22 publications

Prevalence of Cirrhosis in Hepatitis C Patients in the Chronic Hepatitis Cohort Study (CHeCS): A Retrospective and Prospective Observational Study

Prevalence of Cirrhosis in Hepatitis C Patients in the Chronic Hepatitis Cohort Study (CHeCS): A Retrospective and Prospective Observational Study

Systematic review: identifying patients with chronic hepatitis C in need of early treatment and intensive monitoring – predictors and predictive models of disease progression

Alterations in NK Cell Phenotype in Relation to Liver Steatosis in Children with Chronic Hepatitis C

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