Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response

Sofie Hallager; Steen Ladelund; Peer Brehm Christensen; Mette Kjær; Birgit Thorup Roege; Karin Elmegaard Grønbæk; Erika Belard; Toke S. Barfod; Lone Galmstrup Madsen; Jan Gerstoft; Britta Tarp; Henrik Bygum Krarup; Nina Weis

doi:10.2147/CLEP.S132072

Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response

Sofie Hallager^*, Steen Ladelund, Peer Brehm Christensen, Mette Kjær, Birgit Thorup Roege, Karin Elmegaard Grønbæk, Erika Belard, Toke S. Barfod, Lone Galmstrup Madsen, Jan Gerstoft, Britta Tarp, Henrik Bygum Krarup, Nina Weis

^*Corresponding author for this work

Department of Clinical Medicine

10 Citations (Scopus)

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Abstract

Background: Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors. Materials and methods: Patients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013. Results: Of 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43-1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36-1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22-0.62) for HCC and 0.31 (95% CI 0.17-0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR. Conclusion: Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.

Original language	English
Journal	Clinical Epidemiology
Volume	9
Pages (from-to)	501-516
Number of pages	16
ISSN	1179-1349
DOIs	https://doi.org/10.2147/CLEP.S132072
Publication status	Published - Oct 2017

Keywords

Chronic hepatitis C
Cirrhosis
Cohort study
Liver-related morbidity
Sustained virologic response

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2147/CLEP.S132072Licence: CC BY-NC

Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic responseFinal published version, 559 KBLicence: CC BY-NC

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Hallager, S., Ladelund, S., Christensen, P. B., Kjær, M., Roege, B. T., Grønbæk, K. E., Belard, E., Barfod, T. S., Madsen, L. G., Gerstoft, J., Tarp, B., Krarup, H. B., & Weis, N. (2017). Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response. Clinical Epidemiology, 9, 501-516. https://doi.org/10.2147/CLEP.S132072

Hallager, S, Ladelund, S, Christensen, PB, Kjær, M, Roege, BT, Grønbæk, KE, Belard, E, Barfod, TS , Madsen, LG , Gerstoft, J, Tarp, B, Krarup, HB & Weis, N 2017, 'Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response', Clinical Epidemiology, vol. 9, pp. 501-516. https://doi.org/10.2147/CLEP.S132072

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title = "Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response",

abstract = "Background: Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors. Materials and methods: Patients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013. Results: Of 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43-1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36-1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22-0.62) for HCC and 0.31 (95% CI 0.17-0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR. Conclusion: Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.",

keywords = "Chronic hepatitis C, Cirrhosis, Cohort study, Liver-related morbidity, Sustained virologic response",

author = "Sofie Hallager and Steen Ladelund and Christensen, {Peer Brehm} and Mette Kj{\ae}r and Roege, {Birgit Thorup} and Gr{\o}nb{\ae}k, {Karin Elmegaard} and Erika Belard and Barfod, {Toke S.} and Madsen, {Lone Galmstrup} and Jan Gerstoft and Britta Tarp and Krarup, {Henrik Bygum} and Nina Weis",

year = "2017",

month = oct,

doi = "10.2147/CLEP.S132072",

language = "English",

volume = "9",

pages = "501--516",

journal = "Clinical Epidemiology",

issn = "1179-1349",

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TY - JOUR

T1 - Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response

AU - Hallager, Sofie

AU - Ladelund, Steen

AU - Christensen, Peer Brehm

AU - Kjær, Mette

AU - Roege, Birgit Thorup

AU - Grønbæk, Karin Elmegaard

AU - Belard, Erika

AU - Barfod, Toke S.

AU - Madsen, Lone Galmstrup

AU - Gerstoft, Jan

AU - Tarp, Britta

AU - Krarup, Henrik Bygum

AU - Weis, Nina

PY - 2017/10

Y1 - 2017/10

N2 - Background: Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors. Materials and methods: Patients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013. Results: Of 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43-1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36-1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22-0.62) for HCC and 0.31 (95% CI 0.17-0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR. Conclusion: Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.

AB - Background: Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors. Materials and methods: Patients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013. Results: Of 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43-1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36-1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22-0.62) for HCC and 0.31 (95% CI 0.17-0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR. Conclusion: Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.

KW - Chronic hepatitis C

KW - Cirrhosis

KW - Cohort study

KW - Liver-related morbidity

KW - Sustained virologic response

U2 - 10.2147/CLEP.S132072

DO - 10.2147/CLEP.S132072

M3 - Journal article

C2 - 29123424

AN - SCOPUS:85035059744

SN - 1179-1349

VL - 9

SP - 501

EP - 516

JO - Clinical Epidemiology

JF - Clinical Epidemiology

ER -

Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response

Abstract

Keywords

UN SDGs

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