Abnormal hematological indices linked to decompensation, poor response in patients with cirrhosis, HCV

Issue: January 25, 2013

BOSTON — Cirrhotic patients with hepatitis C who had thrombocytopenia with or without leukopenia were less responsive to treatment and more likely to experience decompensation than patients with normal hematologic indices, according to data presented at The Liver Meeting.

Researchers retrospectively analyzed data from the Partners Research Data Repository on 145 adult patients treated for HCV. All included patients received treatment with pegylated interferon and ribavirin, all had compensated liver disease and had hematologic indices (HI) collected prior to treatment. Incidence of sustained virological response (SVR) and decompensation of cirrhosis was recorded, with decompensation defined as the development of new ascites, encephalopathy and variceal hemorrhage during treatment or up to 4 months after completion.

The mean age of the cohort was 56.8 years, with HCV genotype 1 present in 84.9% of cases, genotype 2 in 9.2%, genotype 3 in 4.6% and genotype 4 in 1.3%. The majority of participants (81.0%) were treatment-naive upon initiation of therapy.

Normal HI was observed in 100 patients, while 29 had thrombocytopenia (TH) and 16 had TH with leukopenia (LE). SVR occurred in 30% of patients with normal HI, 20.7% of those with TH and 0% of those with TH and LE (P<.05 for difference). Early decompensation occurred in 1% of patients with normal HI, 10.3% in those with TH and 12.5% of those with TH and LE (P<.05 for difference). Among decompensated patients, 50% experienced encephalopathy, 16.7% developed ascites and 33.3% experienced both. Across the entire cohort, 21.4% of patients dropped out of treatment, with no significant differences between those with normal HI, TH or TH and LE.

Patients with TH were more likely than those with normal HI to experience decompensation (adjusted OR=11.4), while those with TH and LE were at even greater risk (adjusted OR=25.9), according to multivariate analysis controlling for factors including age, MELD and Child-Turcotte-Pugh scores, baseline albumin levels and early termination of treatment.

“Patients with cirrhosis treated with pegylated interferon and ribavirin, who have baseline abnormal HI, are at increased risk for decompensation, as well as reduced response to therapy,” Raffi Karagozian, MD, fellow in the gastroenterology and hepatology division at Brigham and Women’s Hospital in Boston, told Healio.com. “For the clinician, it would be important to closely evaluate these patients ... and to apply closer judgment to decide whether [they] should be treated or not, because they have a higher risk profile and poor response rates.”

For more information:

Karagozian R. P1871: Baseline Hematologic Indices in HCV Cirrhosis Patients are Associated with Response to Antiviral Therapy and Clinical Decompensation. Presented at: The Liver Meeting 2012; Nov. 9-13, .