Complication Of Cirrhosis Research Articles

The serum sodium level and the severity of liver cirrhosis complications: A cross sectional study in BSMMU, Dhaka, Bangladesh

Patients with advanced cirrhosis of liver present with clinical manifestations such as intracta- ble ascites, severe hyponatremia, and reduced arterial blood pressure. The purpose of this study was to observe the relationship between serum sodium levels and the severity of complications associated with liver cirrhosis. From April 2019 to September 2020, this cross-sectional study was done at the Department of Gastrenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 96 patients with cirrhosis of liver from both sexes in the study were enrolled by using sequential sampling. Patients were divided into Child-pugh classes, and the severity of complications were evaluated. The serum sodium level was tested in all of the patients. The relationships between it and various stages and complications of cirrhosis were statistically investigated. Serum sodium level was decreased significantly from child pugh class A to B to C (p value <0.0001). Patients with severe ascites had lower serum sodium level than mild and moderate ascites (p=0.00). In complications of ascites like refractory ascites, spontaneous bacterial peritonitis and hepatore- nal syndrome, mean sodium level was low (<130 mm0l/L) but there was no significant differ- ence among them(p=.091). Level of serum sodium lowered significantly in hepatic encepha- lopathy of grade III & IV than grade I & II and those with no hepatic encephalopathy (p=0.00). But there was no significant difference of serum sodium level among different grades of esophageal varices (P=0.336). Low serum sodium levels were shown to be linked with greater liver dysfunction and the severity of liver cirrhosis-related complications. BSMMU J 2022; 15(1): 20-24

Prevalence And Precipitating Factors Of Hepatic Encephalopathy In Patients With Liver Cirrhosis And Ascites Admitted At Korle Bu Teaching Hospital In Ghana

Background: Hepatic encephalopathy (HE) is one of the most debilitating complications of cirrhosis leading to death and severely affects the lives of patients and their caregivers. Decreases in HE mortality and recurrence have been linked with timely identification and correction of potential precipitating factors and early treatment. The aim of this study was therefore to determine the prevalence and precipitating factors of patients with cirrhotic ascites admitted with overt hepatic encephalopathy at KBTH Accra, Ghana.Materials and Methods: A cross-sectional study was conducted involving one hundred and three (103) patients admitted at medical block in the Korle-Bu Teaching Hospital (KBTH) with cirrhotic ascites from 25th March 2016 to 25th November, 2016. Demographic and clinical features including features of overt hepatic encephalopathy and possible precipitant were collected using a standardized questionnaire. Results: One hundred and three patients with cirrhotic ascites were recruited for the study with a mean age of 43.5 ± 12.2 years. Fifty-eight (56.3%) patients were males. The prevalence of hepatic encephalopathy was 25.24%. Precipitating factors were infections (53.8%),gastrointestinal bleeding (19.2%), electrolyte imbalance (9.2%) and constipation (3.9%). No precipitant was identified for one patient with hepatic encephalopathy.Conclusion: Prevalence of overt hepatic encephalopathy in patients with liver cirrhosis and ascites is not uncommon in our setting and precipitants were identified for almost all of them except one patient. A similar study should be done on a larger scale in multiple centres and regions to get a well-balanced prevalence of hepatic encephalopathy and its precipitating factors.

SAT240 - Impact of COVID-19 on the liver transplant activity in the US: variation by the region, etiology, and cirrhosis complications

SAT240 - Impact of COVID-19 on the liver transplant activity in the US: variation by the region, etiology, and cirrhosis complications

Dementia frequently co-exists with hepatic encephalopathy but not other cirrhosis complications in US veterans with cirrhosis

Dementia frequently co-exists with hepatic encephalopathy but not other cirrhosis complications in US veterans with cirrhosis

Embolization of spontaneous portosystemic shunts as treatment for refractory hepatic encephalopathy

Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.

РОЛЬ ПОЛИМОРФИЗМОВ ГЕНОВ NOS3 И CYBA В ФОРМИРОВАНИИ ОСЛОЖНЕНИЙ ХРОНИЧЕСКОГО ВИРУСНОГО ГЕПАТИТА В Название объекта Название объекта в переводе ФИО автора / список авторов Место работы автора ORCID Ключевые слова Аннотация

In the Republic of Sakha (Yakutia), persistently high incidence rates of CVH remain, as well as mortality rates from complications of liver cirrhosis (LC), as the most common complication. It seems relevant to search for genetic predictors of early development of severe complications in CVH patients in the Yakut population. They can be polymorphic variants of the genes for endothelial dysfunction and oxidative stress NOS3 and CYBA. The collection of representative material was carried out on the basis of the Infectious Diseases Department of the State Budgetary Institution of the Republic of Sakha (Yakutia) of the Yakut Republican Clinical Hospital. In total, 47 DNA samples of patients with chronic viral hepatitis В and liver cirrhosis in its outcome, hospitalized in the Infectious Diseases Department from September 2020 to June 2021, were studied. The control group consisted of patients not infected with viral hepatitis, as well as without pathology of the hemostasis system. The experimental part of the study was carried out by real-time PCR with the melting of hybridization products with a fluorescent label, followed by analysis of the RealBest-Genetics melting curves. As a result of the PCR-RFLP analysis of the rs1799983 polymorphism of the NOS3 gene among patients with chronic viral hepatitis, the T allele frequency was 0.09, and the G allele frequency was 0.91. The frequency of the C allele of the rs2070744 polymorphism of the NOS3 gene was 0.05, the frequency of the T allele was 0.95. The frequency of occurrence of the major allele C of the rs4673 polymorphism of the CYBA gene was 0.78, the minor allele T was 0.22. The relationship between the carriage of polymorphisms of these genes and the disease was not found. However, it was found that carriers of the mutant allele for the rs1799983 polymorphism of the NOS3 gene were 1.81 times more likely to develop liver cirrhosis (95 % CI, odds in the groups 0.176–0.098), carriers of the mutant allele for the rs4673 polymorphism of the CYBA gene were more likely to develop cirrhosis liver cirrhosis is 1.9 times higher (95 % CI, odds in groups 0.211–0.111), in carriers of the mutant allele for the rs2070744 polymorphism of the NOS3 gene, the probability of developing liver cirrhosis is 2.03 times higher (95 % CI, odds in groups 0.181–0.089 ). In carriers of the mutant allele for the rs4673 polymorphism of the CYBA gene, shortening of PT and APTT (17.79 ± 10.26 and 35.13 ± 7.82 sec) is observed, which may indicate a greater tendency of this group to hypercoagulability. In carriers of the mutant allele for the rs2070744 polymorphism of the NOS3 gene, shortening of PT and APTT (11.56 ± 0.99 and 30.12 ± 4.45 sec) is observed, which may also indicate a greater tendency of this group to hypercoagulability.

A prognostic model of acute-on-chronic liver failure based on sarcopenia

BackgroundAcute-on-chronic liver failure (ACLF) is characterized by the development of a syndrome associated with a high risk of short-term death in patients with acute decompensated cirrhosis, and better indicators are needed to predict such outcomes. Sarcopenia, a common complication of cirrhosis, is closely associated with poor prognosis and increased mortality. In this study, the skeletal muscle index of ACLF patients was measured to determine whether sarcopenia combined with clinical parameters can aid in identifying those at high risk of progression.MethodsA total of 433 hospitalized patients with ACLF according to the APASL criteria were included and allocated into two groups: transplantation-free survival (n = 293) or progression (n = 140, 107 died; 33 underwent liver transplantation) within 90 days. Muscle mass was assessed based on the skeletal muscle index. The optimal cut-off value of the AMPAS1 model (age, MELD score, platelet count, alpha-fetoprotein level, sarcopenia, and more than one complication combination) for progression prediction was identified using receiver-operating characteristic (ROC) analysis.ResultsSarcopenia was an independent risk factor for progression in the ACLF population (HR 3.771 95% CI 2.114–6.727, p < 0.001). AMPAS1 was a good predictor, with an area under the ROC curve of 0.865, and the cut-off value for poor outcome prediction was 0.31 (sensitivity 79.4%, specificity 76.4%).ConclusionWe demonstrate that sarcopenia is a simple and objective indicator for predicting short-term prognosis in patients with ACLF. Moreover, compared to conventional prognostic scores, AMPAS1 is a better model for predicting 90 day adverse outcomes in ACLF patients.

EE329 Early Albumin Infusion in Cirrhotic Patients with Spontaneous Bacterial Peritonitis (SBP) Is Associated with Reductions in Total Hospitalization Costs: A Cross-Sectional Study

SBP is a common, life-threatening complication of cirrhosis that imposes a substantial and growing healthcare cost burden. Treatment guidelines from the American Association for the Study of Liver Diseases recommend albumin administration in conjunction with antibiotics for SBP management due to albumin’s demonstrated clinical efficacy and safety. We examined the relationship between albumin infusion timing and total hospitalization cost among cirrhotic inpatients who developed SBP during hospitalization.

EE260 Early Albumin Infusion May Reduce Intensive Care Unit (ICU) Cost in Cirrhotic Patients with Spontaneous Bacterial Peritonitis (SBP): A Cross-Sectional Study

SBP is a serious and costly cirrhosis complication, with ∼50% of cases requiring ICU admission. Due to its demonstrated efficacy in critical care settings, albumin is recommended by the American Association for the Study of Liver Diseases as an adjuvant to antibiotics for the management of SBP. We examined the relationship between early albumin infusion and ICU cost in a subgroup of cirrhotic patients who developed SBP during hospitalization.

Sarcopenia, body composition and factors associated with variceal gastrointestinal bleeding and splenectomy in hepatosplenic schistosomiasis mansoni.

Sarcopenia is a common complication of cirrhosis and an important predictor of morbimortality. We aimed to determine the prevalence of sarcopenia and its associated factors in hepatosplenic schistosomiasis (HSS) as well as to evaluate whether muscle mass and function are associated with variceal upper gastrointestinal bleeding (VUGIB) and previous splenectomy in subjects without other liver diseases. We conducted a cross-sectional study including adults with HSS who underwent clinical, biochemical, anthropometric, muscle strength and physical performance evaluations and were submitted to bioelectrical impedance analysis and abdominal ultrasound. Sarcopenia was diagnosed according to the 2019 European consensus criteria. A total of 66 patients with HSS (62.1% male; mean age 48.8±8.6y) were included. Overall, six subjects (9.1%) were diagnosed with probable sarcopenia and none had confirmed sarcopenia. Fat-free body mass index (BMI) was independently associated with VUGIB (odds ratio 0.701 [95% confidence interval 0.51 to 0.96]; p=0.025). Compared with patients who did not undergo surgery, individuals who underwent esophagogastric devascularization combined with splenectomy (EGDS) had higher serum lipid levels, fat percentage and frequency of metabolic syndrome, with lower skeletal muscle mass index and hand grip strength. HSS mansoni seems not to cause sarcopenia. However, a lower fat-free BMI was associated with previous VUGIB and the subgroup of patients who underwent EGDS presented higher lipid levels, fat percentage and frequency of metabolic syndrome and lower muscle mass and function.

Patients with type 2 diabetes and elevated fibrosis-4 are under-referred to hepatology and have unrecognized hepatic decompensation.

Background and AimThe American Association for the Study of Liver Diseases recommends a high index of suspicion for nonalcoholic steatohepatitis and advanced fibrosis in patients with type 2 diabetes (T2D) and an elevated fibrosis‐4 index (FIB‐4). We investigated the referral pattern of patients with T2D and FIB4 > 3.25 to the hepatology clinic and evaluated the clinical benefits to the patient.MethodsWe included patients aged 18–80 years with T2D and a FIB4 score >3.25 who had visited the internal medicine, family medicine, endocrinology clinic from 01/01/2014–5/31/2019. The first time point of high‐risk FIB‐4 was identified as the baseline for time‐to‐event analysis. The patients were classified based on whether they had visited the hepatology clinic (referred vs not referred).ResultsOf the 2174 patients, 290 (13.3%) were referred to the hepatology clinic, and 1884 (86.7%) were not referred. In multivariate analyses, the referred patients had a lower overall mortality risk (Hazard Ratio: 0.57; 95% CI: 0.38–87). Notably, the referred patients had the same rate of biochemical decompensation, as measured by progression to MELD ≥ 14, but a substantially higher rate of diagnosis in cirrhosis (27, 19–38) and cirrhosis complications, including ascites (2.9, 2.0–4.1), hepatic encephalopathy (99, 13–742), and liver cancer (14, 5–38).ConclusionsWe found that patients with T2D and high‐risk FIB4 are associated with better overall survival after referral to a hepatology clinic. We speculate that the survival difference is due to the increased recognition of cirrhosis and cirrhosis complications in the referred populations.

Safety, Tolerability, Pharmacokinetics, and Efficacy of Terlipressin Delivered by Continuous Intravenous Infusion in Patients with Cirrhosis and Refractory Ascites

Background. Terlipressin is a long acting synthetic analogue of vasopressin, which is used to manage variceal bleeding and hepatorenal syndrome. Terlipressin is being developed to treat refractory ascites in cirrhotic patients who are no longer responsive to diuretic drugs and require repeated paracentesis. This study evaluated the safety, tolerability, pharmacokinetics (PK), and efficacy of a continuous intravenous (IV) infusion of terlipressin as an outpatient treatment for refractory ascites in patients with advanced liver cirrhosis. Methods. This was an open-label Phase 2a trial. Patients received a continuous IV infusion of terlipressin 2 mg/day escalating to 4 mg/d during an initial 7-day inpatient period, followed by 21 days as outpatients. The PK, safety/tolerability, and effects on the need for and volume of paracentesis were evaluated. Results. Four of 6 patients experienced ≥50% increase in the interval between large volume paracenteses (LVP) with terlipressin. The volume of ascites removed by LVP in the 28-day treatment period was reduced in all patients by ≥30% compared with pretreatment. Terlipressin was rapidly eliminated with a mean half-life of 42.3 minutes, mean clearance of 5.6 mL/min/kg, and volume of distribution of 0.33 L/kg. Average steady state plasma concentrations ranged from 1.69 to 5.55 ng/mL and increased proportionally with increasing dose. Three (50.0%) patients reported treatment-related adverse events, but none were serious. Conclusion. Continuous terlipressin IV infusion improved control of refractory ascites with an acceptable safety and predictable PK profile. Further evaluation of terlipressin is warranted in a randomized controlled trial for treating refractory ascites and related complications of cirrhosis.

Metabolomic Analysis Uncovers Lipid and Amino Acid Metabolism Disturbance During the Development of Ascites in Alcoholic Liver Disease.

Ascites is one of the most common complications of cirrhosis, and there is a dearth of knowledge about ascites-related pathologic metabolism. In this study, 122 alcoholic liver disease (ALD) patients, including 49 cases without ascites, 18 cases with mild-ascites, and 55 cases with large-ascites (1) were established according to the International Ascites Club (2), and untargeted metabolomics coupled with pattern recognition approaches were performed to profile and extract metabolite signatures. A total of 553 metabolites were uniquely discovered in patients with ascites, of which 136 metabolites had been annotated in the human metabolome database. Principal component analysis (PCA) analysis was used to further identify 21 ascites-related fingerprints. The eigenmetabolite calculated by reducing the dimensions of the 21 metabolites could be used to effectively identify those ALD patients with or without ascites. The eigenmetabolite showed a decreasing trend during ascites production and accumulation and was negatively related to the disease progress. These metabolic fingerprints mainly belong to the metabolites in lipid metabolism and the amino acid pathway. The results imply that lipid and amino acid metabolism disturbance may play a critical role in the development of ascites in ALD patients and could be a potent prognosis marker.

Patients Hospitalized for Complications of Cirrhosis may Have Benefited From Medicaid Expansion Under the Affordable Care Act

ObjectiveThe benefit of the Affordable Care Act (ACA) for patients with cirrhosis is unclear. We determined the impact of ACA expansion on outcomes in patients hospitalized for complications of cirrhosis. Patients and MethodsWe compared hospitalizations; in-hospital outcomes; and readmissions among patients with cirrhosis identified using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, codes in states that expanded Medicaid under ACA (expanded [E] states) and those that did not (nonexpanded [NE] states). Data from the State Inpatient Databases were obtained for 3 pairs of contiguous E and NE states with both pre-ACA expansion and post-ACA expansion data. The difference-in-difference analysis was performed to compare the pre- and post-ACA data between the E and NE states. The outcomes were admission rates, hospital complications, resource utilization, length of stay, in-hospital mortality, discharge destination, cost of initial hospitalization, and readmission characteristics. ResultsThere were 228,349 admissions (E states, 149,705; NE states, 78,644). After ACA implementation, the E states had lower rates of admission increase per 100,000 population (22.9 in E states vs 25.5 in NE states, P=.005), sepsis (relative risk, 0.884; P=.0084), and hepatic coma (relative risk, 0.763; P<.001) than the NE states. The length of stay was lower by 0.21 days (P=.00028), with a $587.40 lower cost per hospitalization (P=.00091), in the E states than in the NE states. The readmission rates within 30, 60, and 90 days decreased in the E states after ACA implementation but increased in the NE states after ACA implementation. ConclusionAmong patients hospitalized for cirrhosis, quality indicators, such as the rate of admission increase, complications, costs, and readmissions, were more favorable in the states that expanded Medicaid. Medicaid expansion under ACA may have benefited patients with cirrhosis.

Prognostic Nomograms for Hospital Survival and Transplant-Free Survival of Patients with Hepatorenal Syndrome: A Retrospective Cohort Study.

Hepatorenal syndrome (HRS) is a life-threatening complication of cirrhosis with a poor prognosis. To develop novel and effective nomograms which could numerically predict both the hospital survival and transplant-free survival of HRS, we retrospectively enrolled a cohort of 149 patients. A backward stepwise method based on the smallest Akaike information criterion value was applied to select the covariates to be included in the Cox proportional hazards models. The Harrell C-index, area under the receiver operating characteristic curve (AUC), Brier score, and Kaplan–Meier curves with the log-rank test were used to assess nomograms. The bootstrapping method with 1000 resamples was performed for internal validation. The nomogram predicting hospital survival included prothrombin activity, HRS clinical pattern, Child–Pugh class, and baseline serum creatinine. The C-index was 0.72 (95% confidence interval (CI), 0.65–0.78), and the adjusted C-index was 0.72 (95% CI, 0.66–0.79). The nomogram predicting transplant-free survival included sex, prothrombin activity, HRS clinical pattern, model for end-stage liver disease–Na score, and peak serum creatinine. The C-index of the nomogram was 0.74 (95% CI, 0.69–0.79), and the adjusted C-index was 0.74 (95% CI, 0.68–0.79). The AUC and Brier score at 15, 30, and 45 days calculated from the hospital survival nomogram and those at 6, 12, and 18 months calculated from the transplant-free survival nomogram revealed good predictive ability. The two models can be used to identify patients at high risk of HRS and promote early intervention treatment.

Lack of Access to Rifaximin Upon Hospital Discharge Is Frequent and Results in Increased Hospitalizations for Hepatic Encephalopathy.

Hepatic encephalopathy (HE) is a complication of cirrhosis. Rifaximin, added to lactulose, effectively maintains remission and reduces hospitalizations from HE compared with lactulose alone. Although the clinical evidence supports the use of rifaximin, concerns remain regarding the financial implications and subsequent impact on medication access and outcomes. The goal of this study was to determine whether medication access to rifaximin at hospital discharge reduces readmission and office visits related to HE. A retrospective study was conducted in compliance with local institutional review board including cirrhotic patients discharged with a rifaximin prescription for HE. Patients were stratified into 2 groups: those able to obtain rifaximin and those unable to obtain rifaximin upon discharge. The primary outcome was to evaluate the rate of HE recurrence in each group as defined as a composite of readmission or office visit for acute HE within 12 months of discharge. Access to rifaximin significantly reduced the risk of hospital admission and office visit for acute HE over 12 months. A hospitalization or office visit occurred in 24.5% of patients in the medication access group compared with 50% in the group without medication access. Only 58% of patients had access to rifaximin at discharge. Rifaximin use was associated with significantly reduced risk of hospitalization and office visits for HE. At discharge, 42% of patients did not have access to rifaximin regardless of being prescribed the medication, identifying that copay is a significant barrier in allowing patients to have access to rifaximin.

A Liver Stiffness Measurement-Based Nomogram Predicts Variceal Rebleeding in Hepatitis B-Related Cirrhosis.

Background Cirrhosis esophageal variceal rebleeding is a major complication of chronic cirrhosis. The hepatic venous pressure gradient (HVPG) can predict the risk of rebleeding in patients with cirrhosis and has a good correlation with liver stiffness measurement (LSM). However, there are currently few studies based on liver stiffness to predict the risk of rebleeding in patients with liver cirrhosis. This study is aimed at exploring whether liver stiffness can predict rebleeding in patients with hepatitis B virus-related cirrhosis and developing an easy-to-use nomogram for predicting the risk of rebleeding in patients with liver cirrhosis undergoing secondary prevention. Methods A prospective analysis of 289 cirrhosis patients was performed. Univariate and multivariate analyses were used to identify independent prognostic factors to create a nomogram. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots. Results Use of a nonselective beta-blocker (NSBB) drug, LSM, hemoglobin, and platelet count were identified as factors that could predict rebleeding. We created a nomogram for rebleeding in cirrhosis by using these risk factors. The predictive ability of the nomogram was assessed by the C-index (0.772, 95% CI 0.732–0.822). The results of the calibration plots showed that the actual observation and prediction values obtained by the nomogram had good consistency. Conclusions LSM can predict the risk of rebleeding in patients with cirrhosis, while the nomogram is a conventional tool for doctors to facilitate a personalized prognostic evaluation.

Portal Hypertension: Current Concepts

Cirrhosis continues to be a major contributor to the public health burden. Portal hypertensive complications of cirrhosis require extensive interdisciplinary collaborative care, usually at major medical centers with state-of-the-art diagnostic and therapeutic modalities. In many ways, effective management of portal hypertension epitomizes the benefits of optimal interdisciplinary care. As such, I am very pleased and honored to have been invited to be a guest editor for this special issue in Digestive Disease Interventions, as it has provided a unique opportunity to bring together an international panel of experts in gastroenterology, hepatology, surgery, interventional radiology, nephrology, and cardiology, each providing their insights into the care of this complex condition.

Association between medication adherence and disease outcomes in patients with hepatitis B-related cirrhosis: a population-based case–control study

ObjectiveTo evaluate medication adherence among patients with hepatitis B-related cirrhosis who developed decompensation and mortality, and to examine the association between medication adherence and patients’ disease outcomes.DesignIn this retrospective case–control...

The Economic Burden of Viral hepatitis C infection at various stages of the disease in District Mardan, Pakistan

Hepatitis C is a blood-borne, infectious disease caused by the Hepatitis C virus (HCV). It attacks hepatic cells, causing infection and inflammation in the liver, eventually leading to cirrhosis and hepatocellular cancer (HCC). Globally, around 200M people carry HCV with mortality rate of 350,000 due to chronic complications of the liver triggered by HCV. Objective: To assess the overall annual cost borne by chronic HCV patients at various stages of the disease in District Mardan, Pakistan. Methods: Out of total 160 patients, 135, 19 and 6 patients had non-cirrhotic, compensated cirrhosis, decompensated cirrhosis and other complications respectively, Data were obtained from these identified patients’ trough well designed questions based on their social and economic burden in 2019. Descriptive and inferential statistical techniques were applied to estimate the direct and indirect medical costs of HCV in District Mardan. Results: This research discovered a significant link between direct and indirect costs and various phases of viral hepatitis C. The per patient annual indirect costs non-medical costs at different stage of HCV infection was found Rs. 10000 (66.57 $), Rs. 25700 (171.10 $) and Rs. 83200 (553.92 $) for non- cirrhotic, compensated cirrhosis and decompensated cirrhosis patients where non-medical costs were estimated Rs. 2000 (13.31 $), Rs. 3235 (66.57 $), and Rs. 7540 (50.19 $), for non- cirrhotic, compensated cirrhosis and decompensated cirrhosis patients and their average were estimated as Rs.51533 (343.09 $), and 4258.33 (28.35. whereas The estimated per patient direct cost for non-cirrhotic, compensated cirrhosis and decompensated cirrhosis are Rs.51060 (339.94 $), 108650 (723.36 $) and 224370(1493.80 $). Conclusions: It was concluded that indirect medical costs grew up with the progression of disease as productivity loss due to absenteeism increases and traveling expenses increases with increased in number of hospital visits.