Prognosis of chronic hepatitis c: Results of a large, prospective cohort study

Authors

  • Claus Niederau M.D.,

    Corresponding author
    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    • Department of Internal Medicine, St. Josef-Hospital, Academic Teaching Hospital, Mülheimer Str. 83, 46045 Oberhausen, Germany. Fax: 49-208-837309
    Search for more papers by this author
  • Stefan Lange,

    1. Department of Medical Informatics, Biometrics and Epidemiology, Ruhr-Universität Bochum, Bochum, Germany
    Search for more papers by this author
  • Tobias Heintges,

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author
  • Andreas Erhardt,

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author
  • Marlies Buschkamp,

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author
  • Dietmar Hürter,

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author
  • Marek Nawrocki,

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author
  • Lothar Kruska,

    1. Dr. Stein-Laboratory, Mönchengladbach, Germany
    Search for more papers by this author
  • Frank Hensel,

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author
  • Wolfgang Petry,

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author
  • Dieter Häussinger

    1. Department of Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
    Search for more papers by this author

  • Dedicated to Prof. Dr. Georg Strohmeyer on the occasion of his 70th birthday.

Abstract

The prognosis of chronic hepatitis C virus (HCV) infection is still ill-defined. The present study prospectively evaluated mortality and complications in a large cohort of patients with chronic hepatitis C. The study included 838 anti-HCV and HCV-RNA–positive patients who were followed for 50.2 ± 26.9 months (mean ± SD; range, 6-122 months) in a prospective protocol. During follow-up, 62 patients died (31 from liver disease and 31 from other causes), and 12 patients needed liver transplantation. When compared with a matched general population, hepatitis C increased mortality mainly when cirrhosis was present and in patients who were less than 50 years old at study entry. During follow-up, a further 30 patients developed nonlethal complications of cirrhosis. By multivariate regression, survival was decreased by cirrhosis, long disease duration, history of intravenous drug abuse, and excessive alcohol consumption, whereas interferon therapy improved survival. Alanine transaminase (ALT), bilirubin, sex, and genotype had no effect on survival. The risk of hepatocellular carcinoma (HCC) (n = 17) was increased by cirrhosis and to a lesser degree by long disease duration and high bilirubin, whereas interferon therapy, genotype, and other factors had no effect. Chronic hepatitis C is a disease with considerable mortality and morbidity when cirrhosis is present at diagnosis. Patients who acquire the infection early in life have a markedly increased mortality even when cirrhosis is absent at diagnosis. The age at diagnosis therefore should play a major role in therapeutic considerations. The present data also suggest that interferon therapy has a long-term clinical benefit, although it did not reduce the risk of liver cancer.

Ancillary