Which patients with hepatitis C develop liver complications?
Article first published online: 30 DEC 2003
Copyright © 2000 American Association for the Study of Liver Diseases
Volume 31, Issue 2, pages 513–520, February 2000
How to Cite
Khan, M. H., Farrell, G. C., Byth, K., Lin, R., Weltman, M., George, J., Samarasinghe, D., Kench, J., Kaba, S., Crewe, E. and Liddle, C. (2000), Which patients with hepatitis C develop liver complications?. Hepatology, 31: 513–520. doi: 10.1002/hep.510310236
- Issue published online: 30 DEC 2003
- Article first published online: 30 DEC 2003
- Manuscript Accepted: 29 NOV 1999
- Manuscript Received: 23 AUG 1999
To identify variables that are independent predictors of adverse outcomes in chronic hepatitis C, we analyzed a cohort of 455 patients followed for a median of 4.7 years. Associations were sought between demographic and behavioral factors, hepatitis C virus (HCV) genotype, liver histology and liver tests at entry, and development of liver complications, hepatocellular carcinoma (HCC), hepatic transplantation and liver-related death. Independent predictors were identified by multivariate analysis. The following were associated with a significantly higher rate of liver complications: age; birth in Asia, Europe, Mediterranean region, or Egypt; transmission by blood transfusion or sporadic cases; HCV genotypes 1b and 4 (compared with 1/1a); fibrosis stage 3 or 4 (cirrhosis); serum albumin; bilirubin; prothrombin time; and α-fetoprotein. However, the only independent predictors of liver-related complications were sporadic transmission (P < .001), advanced fibrosis (P = .004), and low albumin (P < .001). The corresponding independent risk factors for HCC were male gender (P= .07), sporadic transmission (P < .001), and albumin (P < .001); bilirubin (P= .02) was an additional predictor of transplantation or liver-related death. It is concluded that only patients with advanced hepatic fibrosis or cirrhosis, are at risk of developing hepatic complications of chronic hepatitis C during 5-year follow-up. Among such patients, abnormalities in serum albumin, bilirubin, or prothrombin time indicate a high probability of complications. Patients without definite risk factors for HCV (sporadic cases) are at higher risk of complications, possibly because of interaction between older age, duration of infection, country of birth, and HCV genotypes 1b and 4.