Complications and competing risks of death in compensated viral cirrhosis (ANRS CO12 CirVir prospective cohort)
Year: 2015
Type: article
Study design: Observational Study
Abstract: UNLABELLED: Various critical events, liver related or not, occur in patients with compensated cirrhosis, but their respective burden remains to be prospectively assessed. The aim of this prospective cohort study involving 35 French centers was to capture the whole spectrum of complications occurring in compensated viral cirrhosis (VC) using competing risks analyses. Inclusion criteria were: histologically proven cirrhosis resulting from hepatitis C virus (HCV) or hepatitis B virus (HBV); Child-Pugh A; and no previous hepatic complications. The cohort was considered as a multistate disease model, cumulative incidences (CumIs) of events were estimated in a competing risks framework. A total of 1,654 patients were enrolled from 2006 to 2012 (HCV, 1,308; HBV, 315; HCV-HBV, 31). During a median follow-up of 34 months, at least one liver nodule was detected in 271 patients, confirmed as hepatocellular carcinoma (HCC) in 128 (4-year cumI: 10.5%) and cholangiocarcinoma in 3. HCC incidence was higher in HCV (4-year cumI: 11.4% vs. 7.4%; P = 0.05). HCC fulfilled Milan criteria in 79.3%, leading to curative treatment in 70.4%. Liver decompensation occurred more frequently in HCV patients (4-year cumI: 10.8% vs. 3.6%; P = 0.0004). Virological eradication/control was achieved in 34.1% of HCV and 88.6% of HBV patients and was associated with a marked decrease in HCC, decompensation, and bacterial infection incidences. Survival was shorter in HCV patients (4-year cumI: 91.6% vs. 97.2%; P = 0.0002). Death (n = 102; missing data: 6) was attributed to liver disease in 48 (47%; liver cancer: n = 18; miscellaneous, n = 30) and extrahepatic causes in 48 (47%; bacterial infection: n = 13; extrahepatic cancers: n = 10; cardiovascular events: n = 5; miscellaneous, n = 20). CONCLUSION: After 3 years of follow-up, extrahepatic events still explained half of deaths in patients with compensated VC. A strong decrease in complications was linked to virological eradication/control.
Source: Hepatology
DOI: 10.1002/hep.27743
Authors: Jean‐Claude Trinchet, Valérie Bourcier, Cendrine Chaffaut, Mohand Ait Ahmed, Setty Allam, Patrick Marcellin, Dominique Guyader, Stanislas Pol, Dominique Larrey, Victor De Lédinghen, Denis Ouzan, Fabien Zoulim, Dominique Roulot, Albert Tran, Jean‐Pierre Bronowicki, Jean‐Pierre Zarski, Odile Goria, Paul Calès, Jean‐Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Jean‐Frédéric Blanc, Armand Abergel, Lawrence Serfaty, Ariane Mallat, Jean‐Didier Grangé, Catherine Buffet, Yannick Bacq, Claire Wartelle, Thông Dao, Yves Benhamou, Christophe Pilette, Christine Silvain, Christos Christidis, Dominique Capron, Gérard Thiefin, Sophie Hillaire, Vincent Di Martino, Pierre Nahon, Sylvie Chevret, and the ANRS CO12 CirVir Group
Institutions: Inserm, Université Sorbonne Paris Nord, Génomique Fonctionnelle des Tumeurs Solides, Hôpital Jean-Verdier, Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Louis, Centre de Recherche Épidémiologie et Statistique, Université Paris Diderot, Agence Nationale de Recherches sur le Sida et les Hépatites Virales, Hôpital Beaujon, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Hôpital Cochin, Université Paris Descartes, Hôpital Saint Eloi, Institut Arnault Tzanck, Hospices Civils de Lyon, Hôtel-Dieu de Lyon, Hôpital Avicenne, Centre Hospitalier Universitaire de Nice, Université Nice Sophia Antipolis, Hôpital Albert Michallon, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire d'Angers, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Hôpital Saint Joseph, Hôpital Claude Huriez, Hôpital Saint-André, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Saint-Antoine, Hôpitaux Universitaires Henri-Mondor, Hôpital Tenon, Bicêtre Hospital, Hôpital Armand-Trousseau, Centre Hospitalier Universitaire de Tours, Centre Hospitalier Intercommunal Aix-Pertuis, Centre Hospitalier Universitaire de Caen Normandie, Pitié-Salpêtrière Hospital, Centre Hospitalier du Mans, Centre Hospitalier Universitaire de Poitiers, Institute Mutualiste Montsouris, Hôpital Robert-Debré, Hôpital Foch, Centre Hospitalier Universitaire de Besançon
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2168230293