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Modeling predicts progression of cirrhosis in chronic HCV

The use of simple modeling can be useful in identifying individual risks for progression to cirrhosis among patients with chronic hepatitis C virus infection, according to recent study findings.

Researchers in Spain conducted a retrospective-prospective cohort study using data of 1,289 patients with chronic HCV without cirrhosis from two referral centers in Barcelona, Spain, who received antiviral therapy between 1990 and 2004.   

“A common question in patients, particularly in those with mild disease who may not fulfill criteria for drug reimbursement, is if receiving antiviral therapy can be delayed and, more importantly, for how long. … The main aim of this study [was] to identify which factors are related to disease progression in patients with chronic hepatitis C who did not respond to anti-viral therapy and are potential candidates for oral antiviral treatment,” the researchers wrote.

Patients were followed for a median of 12 years. Overall, 46.6% of patients achieved a sustained virologic response from antiviral therapy.

Data from a randomly split sample of 832 patients was used to estimate a model to predict outcomes. Among 444 patients who were nonresponders, 28% developed cirrhosis (n = 123). Also among these patients, the cumulative probability for developing cirrhosis was 4% at 3 years, 7% at 5 years and 22% at 10 years compared with less than 1% of patients who achieved SVR (P < .05).

Analysis showed fibrosis stage greater than 2, age greater than 40 years, aspartate aminotransferase serum level greater than 100 IU/L and gamma-glutamyl transferase serum level greater than 40 IU/L were all independently associated with progression to cirrhosis in nonresponders. Multiple logistic regression analyses combined these variables and were found to be “highly accurate” for predicting the individual risk for developing cirrhosis, according to the research. The area under the receiving operating characteristic curve were approximately 0.8 at 5, 7 and 10 years. In addition, researchers found the reproducibility of the models in the validation cohort to be high.

“Among patients with chronic hepatitis C, modeling based on simple laboratory and clinical data is helpful at identifying the individual risk of progression to cirrhosis and could be used in clinical practice to better allocate patients in treatment protocols,” the researchers concluded. – by Melinda Stevens

Disclosure: Lens reports advising for Gilead Sciences, Janssen and MSD. Please see the study for a full list of all other authors’ relevant financial disclosures.