12 May Chronic Hepatitis C: Clinical Outcome Tool
MedicalResearch: What are the main findings of the study?
Dr. J van der Meer: The main finding of our study is that the prognosis of patients with compensated HCV-induced advanced liver disease can be adequately assessed by risk scores which merely include objective variables that are readily available in daily practice. Our analyses resulted in two separate prognostic scores by which the individual patient’s risk of mortality or clinical disease progression (defined as occurence of Hepatitis C Cirrhosis (HCC), liver failure, liver transplantation or death) can be assessed.
MedicalResearch: Were any of the findings unexpected?
Dr. J van der Meer: The findings of our study were actually not that unexpected. Included in our risk scores are the variables age, gender, platelet count, AST/ALT ratio and HCV genotype, which all have well-known associations with clinical outcome among patients with HCV-induced liver disease. Indeed, also in our long-term followed cohort of patients with chronic HCV infection and advanced liver disease, these variables were important predictors of all-cause mortality and/or clinical disease progression in general. We were also not surprised by the fact that we could validate our risk scores in an independent cohort of patients with chronic Hepatitis C (HCV) infection and cirrhosis. Validation of the risk scores was very important to show the reliability and robustness of our results.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. J van der Meer: With our risk scores we provide clinicians and their patients with tools to assess the individual patient’s risk of mortality or clinical disease progression during the following years (up to 7.5 years). Clinicians may use these objective scores to counsel their patients with chronic Hepatitis C infection and advanced liver disease. Although the MELD and Child-Pugh scores are frequently used among patients with end-stage liver disease, such prognostic tools have not been available for patients with compensated cirrhosis due to chronic Hepatitis C infection. Reliable assessment of the risk for cirrhosis-related complications may be very relevant when deciding on intensive and costly HCC surveillance or initiation of antiviral therapy, especially as interferon-free regimens will soon become available.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. J van der Meer: It would be relevant to study the accuracy of our risk scores among patients with advanced liver disease due to other causes than chronic Hepatitis C infection, such as HBV, NASH or alcohol abuse. However, differences in the natural history between the various liver diseases might require disease-specific risk scores prior to the stage of decompensated cirrhosis.
Adriaan J van der Meer, Bettina E Hansen, Giovanna Fattovich, Jordan J Feld, Heiner Wedemeyer, Jean-François Dufour, Frank Lammert, Andres Duarte-Rojo, Michael P Manns, Donatella Ieluzzi, Stefan Zeuzem, W Peter Hofmann, Robert J de Knegt, Bart J Veldt, Harry L A Janssen