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Chronic HCV can increase mortality risk from hepatic, extrahepatic diseases

Patients with chronic HCV were at a greater risk for death from diseases both related and unrelated to the liver in a recent study.

Researchers evaluated data from 23,820 Taiwanese patients enrolled between 1991 and 1992 with follow-up through 2008. Participants were tested for seromarker levels of hepatitis B surface antigen (HBsAg), anti-HCV and serum HCV RNA. The cohort included 19,636 HBsAg seronegative patients, of which 18,541 were anti-HCV seronegative. Among 1,095 anti-HCV seropositives, 69.4% had detectable serum HCV RNA levels.

Over a mean follow-up of 16.2 years, 2,394 patients died, 195 because of hepatic disease and 2,199 as a result of extrahepatic disease. Mortality rates were greater among anti-HCV seropositive patients compared with seronegative patients for all causes of death (HR=1.89; 95% CI, 1.66-2.15) and for both hepatic (HR=12.48; 95% CI, 9.34-16.66) and extrahepatic diseases (HR=1.35; 95% CI, 1.15-1.57), according to multivariate analysis. The following HRs (95% CI) were calculated for specific causes of death comparing anti-HCV seropositive patients with seronegative patients:

• chronic liver disease and cirrhosis, HR=5.38 (3.15-9.19)
• circulatory diseases, HR=1.50 (1.10-2.03)
• esophageal cancer, HR=4.08 (1.38-12.08)
• liver cancer, HR=21.63 (14.83-31.54)
• nephritis, nephrotic syndrome and nephrosis, HR=2.77 (1.49-5.15)
• prostate cancer, HR=4.19 (1.18-14.94)
• thyroid cancer, HR=8.22 (1.36-49.66)

Investigators observed that anti-HCV seropositive patients with detectable HCV RNA had higher mortality rates from both hepatic and extrahepatic diseases than seropositives without detectable HCV RNA and patients who were anti-HCV seronegative (P<.001). Cumulative mortality rates after 18 years also were significantly higher among seropositives with detectable HCV RNA than seropositives without detectable RNA and anti-HCV seronegative patients for all causes, as well as for hepatic and extrahepatic diseases specifically (P<.001 for all three).

“In this community-based cohort study, HCV infection was found to be associated with deaths from hepatic and extrahepatic diseases, particularly for those with detectable HCV RNA,” the researchers wrote. “It is implied that anti-HCV seropositives should be consulted regarding their elevated risks. It is also suggested that a serum HCV RNA test with appropriate assay may be helpful to triage HCV-infected patients who need intensive care.”