Difference In Cumulative Probability Research Articles

Sivelestat Inhibits Vascular Endothelial Injury Induced by Inflammatory Response and Improves the Prognosis of Hemorrhagic Fever with Renal Syndrome in Children: An Ambispective Cohort Study.

In Asia, Hanta virus (HTNV) results in severe hemorrhagic fever with renal syndrome (HFRS). The efficacy of sivelestat in treating children with HTNV-induced HFRS remains unclear. An ambispective cohort study was performed on children diagnosed with HFRS and hospitalized at the Children's Hospital Affiliated to Xi'an Jiaotong University from August 2018 to 2023. Patients who received neutrophil elastin-inhibitor infusion between August 2019 and August 2023 were assigned to the sivelestat group, while patients who did not were assigned to the control group. The independent sample t test was used for inter-group analysis. The Chi-square test and Fisher's exact probability test were used for categorical variables. Spearman correlation test was used to evaluate the correlation between two sets of continuous variables. Kaplan-Meier survival curve and Log -Rank test was used to evaluate the difference in cumulative probability of survival between the two groups. No significant differences were observed between the two groups in gender, age, contact history, body mass index, HFRS severity, clinical indexes at admission. Compared to the control group, the sivelestat group exhibited a significant decrease in the interleukin-8 level at 48 h (28.5±3 vs 34.5±3.5) and 72 h (21.3±4.5 vs 31.5±5.6) (P<0.05), as well as the ICAM-1 level at 48 h (553±122 vs 784±187) and 72 h (452±130 vs 623±85) (P<0.05). The concentration of VCAM-1 in the sivelestat group exhibited a consistent downward trend. Moreover, the level of VCAM-1 was significantly lower than that in the control group at 24 h (1760±289 vs 2180±445), 48 h (1450±441 vs 1890±267), and 72 h (1149±338 vs 1500±396) (P<0.05). Kaplan-Meier curve analysis revealed a statistically significant difference in the cumulative probability of survival between two groups (P = 0.041). In the secondary outcomes, the sivelestat group demonstrated a decrease in the utilization rate of mechanical ventilation and continuous renal replacement therapy (CRRT). Sivelestat may suppress neutrophil-mediated inflammatory response to reduce endothelial and organ damage, and improve clinical outcomes in children with severe hemorrhagic fever and renal syndrome.

Incidence of Secondary Bacterial Infections Following Utilization of Tocilizumab for the Treatment of COVID-19 - A Matched Retrospective Cohort Study.

Introduction:Immunosuppressive agents are theorized to target the cytokine storm syndrome in COVID-19. However, the downstream effects regarding susceptibilities to secondary infection risk remains unknown. This study seeks to determine risk differences for secondary infections among COVID-19 patients who did and did not receive tocilizumab.Methods:We conducted a matched retrospective cohort study from two large, acute care hospitals in Western Connecticut from March 1, to May 31, 2020. We collected variables using manual medical record abstraction. The primary exposure variable was any dose of tocilizumab. The primary outcome was any healthcare-associated bacterial or fungal infection as defined by the National Healthcare Safety Network. We performed a Kaplan–Meier analysis to assess the crude difference in cumulative probability of healthcare-associated infection (HAI) across exposure groups. We also performed a multivariable Cox regression analysis to determine the hazard ratio for HAI by exposure group while controlling for potential confounders.Results:The Kaplan–Meier analysis demonstrated no difference in the cumulative probability of HAI across groups. The adjusted hazard of HAI for patients given tocilizumab was 0.85 times that of patients not given tocilizumab (95% confidence interval = 0.29, 2.52, P = 0.780) after controlling for relevant confounders.Conclusions:Tocilizumab did not increase the incidence of secondary infection among COVID-19 patients. Larger, randomized trials should evaluate infection as a secondary outcome to validate this finding.

Does time heal all wounds? Life course associations between child welfare involvement and mortality in prospective cohorts from Sweden and Britain.

Child welfare involvement reflects childhood adversity and is associated with increased adult mortality, but it remains unclear how this association changes over the life course. Drawing on the Stockholm Birth Cohort Multigenerational Study (Sweden) and the National Childhood Development Study (Great Britain) this study examines whether inequalities within these cohorts diverge or converge. Involvement with child welfare services (ICWS) is divided into two levels (‘child welfare contact’ and ‘out-of-home care’). For each cohort, we quantify absolute health inequalities as differences in cumulative probabilities of death (18–58 years) and temporary life expectancy; and relative inequalities as hazard ratios in ten-year intervals and ratios of lifetime lost. Persistently, ICWS was associated with premature mortality. The strength of the association varied by age, sex and level of ICWS. Consistently across both countries, the most robust relationship was between out-of-home care and mortality, with statistically significant age-specific hazard ratios ranging between 1.8 and 3.4 for males and 1.8–2.1 for females. Child welfare contact that did not result in out-of-home placement showed less consistent results. Among females the mortality gap developed later compared to males. Estimates attenuate after controlling for family socioeconomic and other background variables but patterns remain intact. Our results show that absolute inequalities widen with increasing age, while relative inequalities might peak in early adulthood and then stabilize in midlife. The relative disadvantage among looked-after children in early adulthood is heightened by overall low rates of mortality at this age. Absolute inequality increases with age, highlighting the weight of the accumulation of disadvantage in mortality over time. The bulk of excess deaths that could be attributed to ICWS occurs from midlife onwards. Mechanisms that uphold the disadvantage after childhood experiences require further exploration. This study highlights that the association between out-of-home care and premature mortality seems to transcend welfare systems.

P657 Evolution of Crohn’s disease progression and surgery rates over 10 years for patients who initiated biologic treatment early compared with late or no biologic initiation

Abstract Background This study aimed to evaluate the clinical outcomes for adults diagnosed with Crohn’s disease (CD) who started biologic treatments within 2 years of diagnosis (early initiation) compared with those who started biologics &amp;gt;2 years after diagnosis or who did not receive any biologic treatment during the period of observation (late/no biologic initiation). Methods We conducted a retrospective analysis using 10 years of follow-up data from patients included in a national cohort study. We used propensity score methods to match patients in the early vs. late/no biologic initiation groups based on key baseline patient and clinical characteristics. Kaplan–Meier time-to-event models were used to evaluate the risks of intestinal resection surgery, fistula, stricture, and disease flares for each group. In addition, a subgroup analysis was performed stratifying patients known to have initiated biologic treatments into early (≤2 years after diagnosis) vs. late (&amp;gt;2 years after diagnosis) initiation groups. Results In total, 411 patients were matched in the early initiation (n = 230) vs. late/no initiation (n = 181) groups. Two years after diagnosis, early biologic initiators had a 12% lower probability of intestinal resection surgery, a 9% higher probability of disease flares and fistulae, and a 5% higher probability of strictures compared with the late/no biologic initiators (Figure 1). After 10 years, the overall difference in the cumulative probability for each event were not statistically significant between the two groups. In the subgroup analysis, patients who initiated biologics early had a lower overall probability of stricture (p &amp;lt; 0.01), disease flares (p &amp;lt; 0.01), and intestinal resection surgery (p = 0.72), and a higher probability of fistula (p = 0.74) 10 years after diagnosis when compared with the group of patients who initiated biologics late. Conclusion This study found no significant differences in the long-term cumulative probabilities of intestinal resection surgery, fistula, stricture, and disease flares amongst CD patients who initiated biologic treatment early compared with similar patients who initiated biologic therapy late or who had not started any biologic treatments. However, in a subgroup of patients known to receive biologic treatments, early initiation was associated with significantly lower overall risks of strictures and disease flares. These results highlighted the need for more individualised care in CD in order to target aggressive treatment approaches to patients who show early signs of a complicated disease course.

Efficacy and safety of degarelix in patients with prostate cancer: Results from a phase III study in China

ObjectiveTo establish non-inferiority of gonadotropin-releasing hormone degarelix compared with goserelin in suppressing and maintaining castrate testosterone levels from Day 28 to Day 364 in Chinese patients with prostate cancer. MethodsThis is an open-label, multi-centre study in which men aged ≥18 years were randomised in a 1:1 ratio to once-a-month subcutaneous injection of either degarelix (240/80 mg) or goserelin (3.6 mg) for 12 months. The primary endpoint was difference in 1-year cumulative probability of suppressing testosterone to ≤0.5 ng/mL. Non-inferiority was to be established if the lower 95% confidence interval (CI) limit for difference in cumulative probability between the treatment arms was greater than −10%. Secondary endpoints included cumulative probability of prostate-specific-antigen-progression-free-survival (PSA-PFS). Safety was also assessed. ResultsBaseline demographics and disease characteristics were similar between degarelix (n=142) and goserelin (n=141) treatment arms. The difference in cumulative probability of maintaining castrate levels from Day 28–364 was 3.6% (95% CI:−1.5%, 8.7%), demonstrating non-inferiority of degarelix. The cumulative probability of PSA-PFS at Day 364 was higher for degarelix (82.3%, 95% CI: 74.7%, 87.7%) versus goserelin (71.7%, 95% CI: 63.2%, 78.5%, p=0.038). Adverse events (AEs) were similar between treatment arms, except for more injection site reactions with degarelix versus goserelin. Four (2.8%) and nine (6.4%) patients discontinued due to AEs in degarelix and goserelin groups, respectively. ConclusionDegarelix was non-inferior to goserelin in achieving and maintaining testosterone suppression at castrate levels during 1-year treatment. PSA-PFS was significantly higher with degarelix, suggesting improved disease control. Both treatments were well tolerated.

Prioritization of differentially expressed genes through integrating public expression data.

Differentially expressed gene (DEG) analysis is a major approach for interpreting phenotype differences and produces a large number of candidate genes. Given that it is burdensome to validate too many genes through benchwork, an urgent need exists for DEG prioritization. Here, a novel method is proposed for prioritizing bona fide DEGs by constructing the normal range of gene expression through integrating public expression data. Prioritization was performed by ranking the differences in cumulative probability for genes in case and control groups. DEGs from a study on pig muscle tissue were used to evaluate the prioritization accuracy. The results showed that the method reached an area under the receiver operating characteristic curve of 96.42% and can effectively shorten the list of candidate genes from a differential expression experiment to find novel causal genes. Our method can be easily extended to other tissues or species to promote functional research in broad applications.

The efficacy of intravenous thrombolysis in acute ischemic stroke patients with white matter hyperintensity.

ObjectivesWe aimed to investigate effects of deep white matter hyperintensity (DWMH) and periventricular hyperintensity (PVH) on the efficacy of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS).MethodsA total of 113 AIS patients with WMH were categorized into the PVH group and the DWMH group according to the lesion location, with the division of two subgroups based on whether or not they received IVT treatment: the thrombolysis group and the control group. Kaplan–Meier analysis was used for proportional hazards of recurrent stroke. Further, multivariate Cox regression analysis was employed.ResultsOf total patients, there were 62 PVH patients and 51 DWMH patients: 27 of PVH patients and 22 of DWMH patients received IVT, and the remaining patients only received routine treatment. DWMH patients had a higher risk of END (36.4% vs. 11.1%; p = 0.034) and HT (22.7% vs. 3.7%; p = 0.038) than PVH patients in the thrombolysis group. Moreover, DWMH patients undergoing IVT also had a higher risk of END (36.4% vs. 10.3%; x 2 = 5.050; p = 0.025) and HT (22.7% vs. 3.4%; x 2 = 4.664; p = 0.031) than DWMH patients without IVT. Again, PVH patients had a higher rate of recurrent stroke (20.0% vs. 3.4%; p = 0.034) than DWMH patients in the control group after 90‐day follow‐up. Kaplan–Meier analysis showed a significant difference in cumulative probability of no major endpoint events (p = 0.039). Further, multivariate Cox regression revealed that PVH is an independent risk factor for stroke recurrence in AIS patients after adjusting confounding factors.ConclusionsThe location of WMH is closely associated with the efficacy of IVT in AIS patients.

Prospective evaluation of luteal phase length and natural fertility

To evaluate the impact of a short luteal phase on fecundity. Prospective time-to-pregnancy cohort study. Not applicable. Women trying to conceive, ages 30-44years, without known infertility. Daily diaries, ovulation prediction testing, standardized pregnancy testing. Subsequent cycle fecundity. Included in the analysis were 1,635 cycles from 284 women. A short luteal phase (≤11days including the day of ovulation) occurred in 18% of observed cycles. Mean luteal phase length was 14days. Significantly more women with a short luteal phase were smokers. After adjustment for age, women with a short luteal phase had 0.82 times the odds of pregnancy in the subsequent cycle immediately following the short luteal phase compared with women without a short luteal phase. Women with a short luteal length in the first observed cycle had significantly lower fertility after the first 6months of pregnancy attempt, but at 12months there was no significant difference in cumulative probability of pregnancy. Although an isolated cycle with a short luteal phase may negatively affect short-term fertility, incidence of infertility at 12months was not significantly higher among these women. NCT01028365.

355 - Influence of Diabetes and Glycemic Control on Mortality in Left Ventricular Assist Device Patients

Introduction: Prior studies have shown that patients with diabetes have worse surgical outcomes compared with individuals without diabetes. Despite previous studies, the risk of mortality of diabetic patients post left ventricular assist device (LVAD) implant, remains unclear. In addition, the relationship between the degree of glycemic control and long-term mortality risk in LVAD patients with diabetes has not been established. Hypothesis: We hypothesized that LVAD patients without diabetes would have lower mortality than LVAD patients with diabetes, and amongst LVAD diabetic patients, mortality would increase with worse diabetes control (higher hemoglobin A1c). Methods: 95 non-diabetic and 96 diabetic patients from the University of Rochester Medical Center, Rochester, NY who received a HeartMate II continuous-flow LVAD between 8/26/2007 and 6/30/2014 were included in this study. Diabetics were defined as having a diagnosis of diabetes in medical records, or hemoglobin A1c greater than or equal to 6.5%, or random glucose greater than 200 mg/dL on more than one occasion prior to LVAD implantation. The primary outcome was all-cause mortality. Kaplan-Meier cumulative probabilities of long-term all-cause mortality were assessed by diabetes, and by the degree of glycemic control. Results: During follow-up, 32 (33%) individuals with diabetes and 15 (16%) individuals without diabetes died following LVAD implantation (P = .005). Cumulative probability of death was higher in diabetics when compared to non-diabetics (42% vs. 21% at 3 years, P = .008, Fig. 1). There was no statistically significant difference in cumulative probability of death between diabetics with pre-LVAD hemoglobin A1c < 7.5% and diabetics with pre-LVAD hemoglobin A1c ≥7.5% (P = .198, Fig. 2). Conclusions: Diabetics who undergo LVAD implantation have a higher probability of death compared with non-diabetic patients. However, the degree of glycemic control in patients with diabetes did not influence mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Leukoaraiosis and stroke recurrence risk in patients with and without atrial fibrillation.

We aimed to investigate the association between leukoaraiosis and long-term risk of stroke recurrence adjusting for clinical scores developed and validated for the prediction of stroke risk, such as CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or TIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or TIA, vascular disease, age 65-74 years, sex category). Study population was derived from the Athens Stroke Registry and was categorized in 2 subgroups according to the presence of atrial fibrillation (AF). Cox proportional hazards analysis was performed to assess the independent predictors of stroke recurrence. To investigate whether leukoaraiosis adds to the prognostic accuracy of CHADS2 and CHA2DS2-VASc scores, we used the likelihood ratio test. Overall model assessment was performed with Nagelkerke R(2) and Harrell C statistic. Kaplan-Meier analyses were also performed. Among 1,892 patients, there were 320 (16.9%) with leukoaraiosis and 670 (35.4%) with AF. In the Kaplan-Meier analysis, there was significant difference in cumulative probability of stroke recurrence between patients with and without leukoaraiosis in the non-AF group (p < 0.01), but not in the AF group (p = 0.46). On Cox multivariate analysis, leukoaraiosis was found to be a significant independent predictor of stroke recurrence only in the non-AF group, in the models adjusting for CHADS2 (hazard ratio: 1.86, 95% confidence interval: 1.35-2.56) and CHA2DS2-VASc (hazard ratio: 1.82, 95% confidence interval: 1.32-2.51) scores. Leukoaraiosis was not a predictor of stroke recurrence in the AF group. Leukoaraiosis did not improve the predictive accuracy of the 2 scores, whether in the non-AF group (Harrell C statistic: 0.56 vs 0.59 [p = 0.31] for the model including CHADS2; 0.56 vs 0.59 [p = 0.44] for the model including CHA2DS2-VASc) or the AF group (Harrell C statistic: 0.63 vs 0.62 for the model including CHADS2; 0.64 vs 0.64 for the model including CHA2DS2-VASc). Leukoaraiosis is an independent predictor of stroke recurrence in non-AF stroke patients. However, leukoaraiosis did not increase the accuracy of the CHADS2 and CHA2DS2-VASc scores to predict stroke recurrence in AF or non-AF stroke patients.

P430 Long-term outcome of Crohn's disease patients treated with infliximab

and reoperation between two groups using the Kaplan Meier method and a log-rank test. Results: Of a total 721 patients, 443 (61.4%) were the second group. Although the cumulative probabilities of immunosuppressant (P< 0.001) and IFX use (P< 0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P= 0.905) and reoperation (P= 0.418) between two groups. Conclusions: The early use of IFX did not reduce CD-related surgery requirements in Korean patient with CD. Our results suggest that the early use of IFX may have little impact in the clinical outcome of Korean CD in the setting of a conventional step-up algorithm.

P431 Long-term efficacy of maintenance therapy with thiopurines in Crohn's disease

and reoperation between two groups using the Kaplan Meier method and a log-rank test. Results: Of a total 721 patients, 443 (61.4%) were the second group. Although the cumulative probabilities of immunosuppressant (P< 0.001) and IFX use (P< 0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P= 0.905) and reoperation (P= 0.418) between two groups. Conclusions: The early use of IFX did not reduce CD-related surgery requirements in Korean patient with CD. Our results suggest that the early use of IFX may have little impact in the clinical outcome of Korean CD in the setting of a conventional step-up algorithm.

Long-term clinical outcomes of korean patient with Crohn's disease following early use of infliximab.

Background/AimsSeveral recent studies have reported that the early use of infliximab (IFX) improves the prognosis of Crohn's disease (CD). However, no data are available from Asian populations, as the forementioned studies have all been conducted in Western countries. The aim of the current study was to evaluate the impact of early use of IFX on the prognosis of Korean patients with CD.MethodsPatients with a diagnosis of CD established between July 1987 and January 2012 were investigated in 12 university hospitals in Korea. Because insurance coverage for IFX treatment began in August 2005, patients were assigned to either of 2 groups based on diagnosis date. The first group included patients diagnosed from July 1987 to December 2005, and the second from January 2006 to January 2012. We compared the cumulative probabilities of operation and reoperation between the two groups using the Kaplan-Meier method and a log-rank test.ResultsOf the 721 patients investigated, 443 (61.4%) comprized the second group. Although the cumulative probabilities of immunosuppressant (P<0.001) and IFX use (P<0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P=0.905) or reoperation (P=0.418) between two groups.ConclusionsThe early use of IFX did not reduce CD-related surgery requirements in Korean patients with CD. These study results suggest that the early use of IFX may have little impact on the clinical outcome of CD in Korean patients in the setting of a conventional step-up algorithm.

Influence of age at diagnosis and sex on clinical course and long-term prognosis of intestinal Behcetʼs disease

The aim of this study was to examine the influence of age at diagnosis and sex on the clinical course and long-term prognosis of intestinal Behcet's disease (BD). We reviewed the medical records of 291 patients with intestinal BD who underwent regular follow-up at a single tertiary academic medical center. The patients were divided into two groups according to their age at diagnosis of intestinal BD or sex. The cumulative probabilities of operation, admission, corticosteroid use, and immunosuppressant use after diagnosis were analyzed using the Kaplan-Meier method and a log-rank test. Of the 291 patients, 154 (52.9%) were diagnosed with intestinal BD when younger than 40 years old, and 132 (45.4%) were male. Younger age at diagnosis was associated with a higher leukocyte count, C-reactive protein (CRP) level, and disease activity index for intestinal BD, and with a greater prevalence of volcano-shaped ulcers and a definite diagnostic subtype. Moreover, the cumulative probabilities of operation, admission, and corticosteroid use were significantly higher in the younger group. Male sex was associated with a higher CRP level and a greater prevalence of volcano-shaped ulcers. However, there were no significant differences in cumulative probabilities of operation, admission, corticosteroid use, and immunosuppressant use according to sex. In intestinal BD, younger age at diagnosis is associated with a more severe clinical course and a poorer prognosis. However, although some clinical manifestations at initial diagnosis tend to be more severe in male patients, clinical outcomes do not differ significantly according to sex.

Predictive Value of Liver Cell Dysplasia for Development of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B

We aimed to determine whether the presence of large liver cell dysplasia (LLCD) and/or small LCD (SLCD) in chronic hepatitis B is a risk factor for hepatocellular carcinoma (HCC) development. A close relationship between LLCD/SLCD and hepatitis B virus has been observed and SLCD has been proposed to be a putative precursor of HCC, whereas the significance of LLCD is still controversial. One hundred eighty-one patients with chronic hepatitis B who underwent needle liver biopsy were evaluated for the presence of LLCD/SLCD. The predictive value of LLCD/SLCD for HCC development was assessed. LLCD and SLCD were present at initial biopsy in 82 (45%) and 17 (9%) patients, respectively. During the mean follow-up of 115+/-48 months, 19 (10%) cases were diagnosed of HCC, of which 13 (76%) and 3 (17%) cases had demonstrated LLCD and SLCD, respectively, at initial evaluation. The patients with LLCD showed a significantly higher cumulative probability of HCC development than those without LLCD (P=0.016). The risk of HCC development in the presence of LLCD was approximately 3-fold, with positive and negative predictive values of 15.9% and 94.9%, respectively. The patients with SLCD showed no significant difference in cumulative probability of HCC development compared with those without (P>0.05). LLCD in chronic hepatitis B is considered to be one of the risk factors for HCC development and its presence may help to identify a high-risk subgroup of patients requiring more intensive screening for HCC.

Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis

To test whether symptomatic severe intracranial atherosclerotic stenosis was associated with a higher subsequent stroke risk than moderate stenosis after elective angioplasty with a balloon-expandable stent and to explore which factors were associated with the subsequent stroke. Between September 2001 and June 2005, there were 220 symptomatic intracranial atherosclerotic stenoses in 213 patients undergoing elective stenting at our institute. Of these stenoses, 126 in 121 patients were > or =70% severe stenoses, and 94 in 92 patients were 50% to 69% moderate stenoses. Primary endpoints included lesion-related ischemic stroke, and symptomatic brain or subarachnoid hemorrhage. Ten primary endpoint events occurred in the severe stenosis group (six within 30 days and four in mean follow-up of 26.0 months after 30 days), and seven occurred in the moderate stenosis group (four within 30 days and three in mean follow-up of 27.6 months after 30 days). There was no significant difference in cumulative probability of primary endpoints between the severe (7.2% at 1 year and 8.2% at 2 years) and moderate (5.3% at 1 year and 8.3% at 2 years) stenosis groups. No single factor was found to be associated with primary endpoints in the moderate stenosis group. Multivariable analysis revealed that stent failure was the only predictor of primary endpoints in the severe stenosis group (hazard ratio 5.31, 95% CI 1.35 to 20.91). Symptomatic severe intracranial atherosclerotic stenosis did not present a higher subsequent stroke risk than moderate stenosis after elective angioplasty with a balloon-expandable stent. Patients with severe stenosis may benefit from successful stent placement, and randomized trials are necessary to demonstrate this possible benefit.

A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase

Background: Detectable serum hepatitis C virus (HCV) RNA in HCV patients with persistently normal alanine transaminase (PNALT) has been found to be associated with significant liver damage. Aims: The primary outcome of this study was to compare the histological progression of fibrosis in patients with PNALT and elevated alanine transaminase (ALT). Methods: Forty patients with PNALT (Group 1) and 41 patients with elevated ALT (Group 2) were recruited into this study. Only patients with fibrosis of F0 to F2 were recruited into this study. Results: The median time to second liver biopsies was 6.3 (range 2.0–11.1) years. Nine patients (22.5%) in Group 1 and 17 patients (41.5%) from Group 2 had progression of fibrosis. There was a trend towards a significantly higher cumulative probability of fibrosis progression in Group 2 ( P=0.06). In patients with an initial F0 to F1 fibrosis, there was a significant difference in cumulative probability of fibrosis progression between Groups 1 and 2 (22.6% (7/31) vs. 43.3% (13/31), respectively, P=0.02). Conclusions: Anti-HCV patients with PNALT with an initial fibrosis of F0 or F1 were less likely to develop progression of fibrosis than those with elevated ALT, although patients with PNALT may have histologically and clinically progressive disease.