Mortality in patients with Chronic Hepatitis C and cirrhosis compared to the general population – a Danish cohort study

Hallager, Sofie; Christensen, Peer Brehm; Ladelund, Steen; Clausen, Mette Rye; Laursen, Alex Lund; Møller, Axel; Schlicthting, Poul; Madsen, Lone Galmstrup; Gerstoft, Jan; Lunding, Suzanne; Grønbæk, K.; Krarup, Henrik; Weis, Nina

doi:10.1093/infdis/jiw527

Cited by 13 publications

(23 citation statements)

References 33 publications

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“…These trends were dominated by a rise in HCV‐associated cirrhosis and HCC, with a much smaller contribution from NAFLD and ALD . Another recent study from Europe demonstrated a reduction in mortality rate associated with achieving sustained virologic response among patients with HCV‐related cirrhosis . In our study, a steep decline in the HCV‐related mortality rate was observed during the DAA era from 3.68 per 100,000 persons in 2014 to 3.2 per 100,000 persons in 2016, with a rate of 6.5% decline per year.…”

Section: Discussionsupporting

confidence: 50%

Changing Trends in Etiology‐Based and Ethnicity‐Based Annual Mortality Rates of Cirrhosis and Hepatocellular Carcinoma in the United States

et al. 2019

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Cirrhosis- and HCC-related mortality rates increased between 2007 and 2016 in the US. However, mortality rates in HCV-cirrhosis demonstrated a significant decline from 2014-2016, during the direct-acting antiviral era. Mortality rates for ALD/NAFLD-cirrhosis and HCC have continued to increase, while HBV-cirrhosis-related mortality declined during the 10-year period. Importantly, minorities had a disproportionately higher burden of ESLD-related mortality. This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 50%

Changing Trends in Etiology‐Based and Ethnicity‐Based Annual Mortality Rates of Cirrhosis and Hepatocellular Carcinoma in the United States

et al. 2019

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“…The benefit of treatment for those with mild inflammation or fibrosis is less certain. Since the risk of complications increases dramatically once cirrhosis develops, it is of particular importance to detect patients with early cirrhosis …”

Section: Introductionmentioning

confidence: 99%

Are non‐invasive fibrosis markers for chronic hepatitis B reliable in sub‐Saharan Africa?

Desalegn

Aberra

Berhe

et al. 2017

Liver International

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BackgroundIn the absence of liver biopsy, the World Health Organization recommends non‐invasive tests, such as aspartate aminotransferase to platelet ratio index and FIB‐4, to assess liver fibrosis in patients with chronic hepatitis B. However, these tests are not well validated in sub‐Saharan Africa. Recently, a new marker, gamma‐glutamyl transpeptidase to platelet ratio, was found to be more accurate in an African setting, but this needs confirmation in other cohorts.MethodsA treatment program for chronic hepatitis B was initiated in Addis Ababa, Ethiopia, in 2015. Non‐invasive tests were compared with transient elastography (Fibroscan 402, Echosense, France) using the following thresholds: no fibrosis (≤7.9 kPa), significant fibrosis (>7.9 kPa) and cirrhosis (>11.7 kPa). The diagnostic accuracy was estimated by calculating the area under the receiver operating characteristics curve.ResultsOf 582 treatment‐naïve patients, 141 (24.2%) had significant fibrosis and 90 (15.5%) had cirrhosis. The area under the receiver operating characteristics curve of aspartate aminotransferase to platelet ratio index, FIB‐4 and gamma‐glutamyl transpeptidase to platelet ratio was high both to diagnose significant fibrosis (0.79 [95% CI 0.75‐0.84], 0.79 [95% CI 0.75‐0.84], 0.80 [95% CI 0.75‐0.85]) and cirrhosis (0.86 [95% CI 0.81‐0.91], 0.86 [95% CI 0.81‐0.91], 0.87 [95% CI 0.82‐0.91]). The specificity was high for all tests (94%‐100%); however, the sensitivity was poor both to detect fibrosis (10%‐45%) and cirrhosis (10%‐36%).ConclusionsAspartate aminotransferase to platelet ratio index, FIB‐4 and gamma‐glutamyl transpeptidase to platelet ratio had good diagnostic properties to detect liver fibrosis and cirrhosis in patients with chronic hepatitis B in East Africa. However, the sensitivity was low, and only 10% of patients with cirrhosis were detected using aspartate aminotransferase to platelet ratio index at the World Health Organization recommended threshold.

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“…With regard to our study, one possible explanation could be that our study was a real life cohort study with expectedly less than perfect surveillance assuming that surveillance provides a survival benefit . Our current study exclusively included CHC patients with cirrhosis and the cohort showed a high prevalence of alcohol overuse, IDU, decompensation and psychiatric disease—all of which are associated with poor survival and negatively associated with surveillance . With regard to HCC treatment, we only had reliable data on LTX, and we found that nine patients (7.8%) received LTX after HCC.…”

Section: Discussionmentioning

confidence: 95%

“…Differences in the application of LTX are likely to reflect national and regional traditions and availability of organs as well as eligibility of patients. We attribute the poor survival in this study to the advanced HCC stage and the high overall mortality of the cohort …”

Section: Discussionmentioning

confidence: 99%

“…The Danish healthcare system is free of charge to the individual, and due to the unique personal identification number (PIN), linkage between nationwide registries is possible . National health registries used in this study have been described in details elsewhere . The central registry was the Danish Database for Hepatitis B and C (DANHEP) , with ongoing enrolment since 1 January 2002 of patients with CHC and/or chronic hepatitis B (CHB) attending specialized care.…”

Section: Methodsmentioning

confidence: 99%

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Hepatocellular carcinoma in patients with chronic hepatitis C and cirrhosis in Denmark: A nationwide cohort study

Hallager

Ladelund

Kjær

et al. 2017

Journal of Viral Hepatitis

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SummaryCirrhosis in patients with chronic hepatitis C increases the risk of hepatocellular carcinoma (HCC), and surveillance with ultrasound (US) and alpha-fetoprotein (AFP) is recommended. This study aimed to estimate changes in the HCC incidence rate (IR) over time, HCC stage and prognosis, and AFP and US performed in patients with hepatitis C and cirrhosis. Eligible patients were identified in the Danish Database for Hepatitis B and C, and data from national health registries and patient charts were obtained.

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Mortality in patients with Chronic Hepatitis C and cirrhosis compared to the general population – a Danish cohort study

Abstract: MRs were high among patients with CHC with or without cirrhosis compared with the general population. Curing CHC was associated with a reduction in MR among cirrhotic patients, but the MR remained higher than the general population.

Cited by 13 publications

References 33 publications

Changing Trends in Etiology‐Based and Ethnicity‐Based Annual Mortality Rates of Cirrhosis and Hepatocellular Carcinoma in the United States

Changing Trends in Etiology‐Based and Ethnicity‐Based Annual Mortality Rates of Cirrhosis and Hepatocellular Carcinoma in the United States

Are non‐invasive fibrosis markers for chronic hepatitis B reliable in sub‐Saharan Africa?

Hepatocellular carcinoma in patients with chronic hepatitis C and cirrhosis in Denmark: A nationwide cohort study

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