Prognosis of 1169 hepatitis C chronically infected patients with decompensated cirrhosis in the predirect‐acting antiviral era

Abstract

At a population level, little is known regarding the risk of liver- and nonliver-related mortality and hospitalization and the development of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-infected patients with decompensated cirrhosis (DC). This large-scale national record-linkage study estimates these outcomes following first hospital admission for DC. Record-linkages between national HCV diagnosis and clinical databases and the national inpatient hospital episode database and mortality register were conducted to follow-up the disease course of all identified HCV-diagnosed and chronically infected persons. The study population consisted of 1169 HCV chronically infected persons who had a first hospital admission for DC within the period 1994-2013. We observed an overall average annual percentage change of 12.6% in new DC patients (from 63 in 1994-1999 to 541 in 2009-2013), with no evidence for any improvement in the relative risks of liver-related or all-cause death over time. Between 1 January 1994 and 31 May 2014, 722 and 95 DC patients had died of a liver- and a nonliver-related cause, respectively, and 106 patients had a subsequent first admission for HCC. The 5-year cumulative incidence of liver-related mortality, nonliver-related mortality and first subsequent HCC admission was 61.3%, 8.2% and 8.8%, respectively. The health burden in HCV-infected patients associated with development of decompensated cirrhosis has increased dramatically over the last 20 years. Our findings establish the baseline mortality and HCC progression rates in DC patients against which the impact of new antiviral therapies can be measured.

Real‐world impact following initiation of interferon‐free hepatitis C regimens on liver‐related outcomes and all‐cause mortality among patients with compensated cirrhosis

“…Among this large chronically HCV‐infected cohort of compensated cirrhosis patients receiving IFN‐free DAA therapy, treatment response was associated with a profound reduction in the relative risks of progression to decompensated liver disease and mortality. Before the advent of DAA therapy, the health burden in HCV‐infected patients associated with development of DC was bleak, with a sustained increase in DC cases observed between 1994 and 2013 . The anticipated immediate reduction in HCV‐driven disease with DAA scale‐up of patients with advanced liver fibrosis emphasizes the credibility of using compensated cirrhosis as an early marker of DAA impact and success .…”

“…Note: Person-time was calculated as period from date of treatment initiation through the earliest of date of endpoint and censoring date. bleak, with a sustained increase in DC cases observed between 1994 and 2013 26. The anticipated immediate reduction in HCV-driven dis-ease with DAA scale-up of patients with advanced liver fibrosis emphasizes the credibility of using compensated cirrhosis as an early marker of DAA impact and success.…”

Inpatient hospital burden of hepatitis C‐diagnosed patients with decompensated cirrhosis

“…The apparent greatly improved disease course in a proportion of our DC patients (as indicated by no further inpatient admissions after an initial cluster of DC and other liver‐related admissions) could indicate reversal of severe disease, potentially via successful transplantation. However, relatively few liver transplantations took place during the study period, and transplant patients in Scotland can have an inpatient record generated with a code indicating prior liver transplantation; this occurred for only a small proportion …”

“…DC discharge diagnosis codes were categorized into: hepatic failure (aggregating the diagnosis codes comprising chronic hepatic failure, alcoholic hepatic failure and hepatorenal syndrome), ascites and bleeding oesophageal varices (for ICD‐10 codes comprising these definitions see Table ). The selected diagnosis codes have been used in previous DC research . We use the terms admission and discharge equivalently, assuming that discharge diagnoses encode the reason for admission.…”

“…with no evidence for any improvement in mortality risk over the 20-year study period 1994-2013. 3 Upon expansion of DAA treatment to DC-stage patients, 4 promising reported viral clearance rates 5,6 may translate to improved survival, but data from long-term follow-up studies are not yet available.…”