Abstract
Background and AimsIn patients with advanced liver cirrhosis due to chronic hepatitis C virus (HCV) infection antiviral therapy with peginterferon and ribavirin is feasible in selected cases only due to potentially life-threatening side effects. However, predictive factors associated with hepatic decompensation during antiviral therapy are poorly defined.MethodsIn a retrospective cohort study, 68 patients with HCV-associated liver cirrhosis (mean MELD score 9.18±2.72) were treated with peginterferon and ribavirin. Clinical events indicating hepatic decompensation (onset of ascites, hepatic encephalopathy, upper gastrointestinal bleeding, hospitalization) as well as laboratory data were recorded at baseline and during a follow up period of 72 weeks after initiation of antiviral therapy. To monitor long term sequelae of end stage liver disease an extended follow up for HCC development, transplantation and death was applied (240weeks, ±SD 136weeks).ResultsEighteen patients (26.5%) achieved a sustained virologic response. During the observational period a hepatic decompensation was observed in 36.8%. Patients with hepatic decompensation had higher MELD scores (10.84 vs. 8.23, p<0.001) and higher mean bilirubin levels (26.74 vs. 14.63 µmol/l, p<0.001), as well as lower serum albumin levels (38.2 vs. 41.1 g/l, p = 0.015), mean platelets (102.64 vs. 138.95/nl, p = 0.014) and mean leukocytes (4.02 vs. 5.68/nl, p = 0.002) at baseline as compared to those without decompensation. In the multivariate analysis the MELD score remained independently associated with hepatic decompensation (OR 1.56, 1.18–2.07; p = 0.002). When the patients were grouped according to their baseline MELD scores, hepatic decompensation occurred in 22%, 59%, and 83% of patients with MELD scores of 6–9, 10–13, and >14, respectively. Baseline MELD score was significantly associated with the risk for transplantation/death (p<0.001).ConclusionsOur data suggest that the baseline MELD score predicts the risk of hepatic decompensation during antiviral therapy and thus contributes to decision making when antiviral therapy is discussed in HCV patients with advanced liver cirrhosis.
Highlights
Chronic hepatitis C virus (HCV) infection is a major health burden with more than 170 million infected individuals worldwide
For more than one decade, available antiviral treatment consisted of a dual therapy with pegylated interferon alfa-2a or 2b in combination with the guanosine analog ribavirin leading to sustained virologic response (SVR) rates in approximately half of the patients [3,4]
In this retrospective cohort study we investigated 68 consecutive patients with advanced liver cirrhosis due to hepatitis C infection that were treated with pegylated interferon alfa-2a or 2b and ribavirin between the years 2002 and 2010 at the outpatient liver clinic of the J
Summary
Chronic hepatitis C virus (HCV) infection is a major health burden with more than 170 million infected individuals worldwide. For more than one decade, available antiviral treatment consisted of a dual therapy with pegylated interferon alfa-2a or 2b (peginterferon) in combination with the guanosine analog ribavirin leading to sustained virologic response (SVR) rates in approximately half of the patients [3,4]. Licensing of the new HCV protease inhibitors boceprevir and telaprevir, as part of a triple therapy for untreated HCV genotype 1 patients and those who failed previous treatment, represents a milestone in HCV treatment. Patients with a previous virologic relapse, partial response, or non-response to peginterferon and ribavirin benefit when retreated with boceprevir or telaprevir-containing triple therapies [8,9]. In patients with advanced liver cirrhosis due to chronic hepatitis C virus (HCV) infection antiviral therapy with peginterferon and ribavirin is feasible in selected cases only due to potentially life-threatening side effects. Predictive factors associated with hepatic decompensation during antiviral therapy are poorly defined
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