Natural
History of Liver Cirrhosis Due to Hepatitis C
Past
research has shown that a proportion of patients with chronic hepatitis C go on
to develop progressive liver disease including advanced
fibrosis, cirrhosis, and hepatocellular
carcinoma (HCC) over a period of 10-40 years.A
study published in the June 2006 issue of Hepatology provided further information
about the long-term progression of hepatitis C-related liver damage. The
researchers analyzed data from a cohort of 214 patients with compensated hepatitis
C-related cirrhosis who were prospectively followed for 17 years. The patients
had Child-Pugh class A cirrhosis and no previous clinical decompensation. Follow-up
included periodic clinical and abdominal ultrasound examinations. Results  | Over
114 months of follow-up (range 1-199), observed evidence of liver disease progression
was as follows:-
HCC developed in 68 patients (32%); annual incidence rate 3.9%
- ascites in
50 patients (23%); annual incidence rate 2.9%
- jaundice in 36 patients (17%);
annual incidence rate 2.0%
- upper gastrointestinal bleeding in 13 patients
(6%); annual incidence rate 0.7%
- encephalopathy in 2 patients (1%); annual
incidence rate 0.1 |
| | Clinical
status remained unchanged in 154 patients (72%); 45 patients (21%) progressed
to Child-Pugh class B and 15 patients (7%) progressed to class C. | | HCC
was the first complication to develop in 58 patients (27%), followed by ascites
in 29 patients (14%), jaundice in 20 patients (9%), and upper gastrointestinal
bleeding in 3 patients (1%). | | HCC
was the major cause of mortality, responsible for 44% of deaths
| | The
annual mortality rate was 4.0% per year, and was higher in patients who had additional
potential causes of liver disease (5.7% vs 3.6%; P = .04). | | Among
the groups with persistently normal, currently high, and |
Conclusion The
authors concluded that hepatitis C-related cirrhosis is a "slowly progressive
disease that may be accelerated by other potential causes of liver disease."
HCC was the first complication to develop, and the dominant cause for increased
mortality. 6/16/06 Reference
A
Sangiovanni, GM Prati, P Fasani, and others. The natural history of compensated
cirrhosis due to hepatitis C virus: a 17-year cohort study of 214 patients. Hepatology
43(6): 1303-1310. June 2006.
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