LIVER RELATED EVENTS AND SURVIVAL IN PATIENTS WITH COMPENSATED HCV CIRRHOSIS: THE ROLE OF SVR TO PEG-IFN BASED THERAPY AND PORTAL HYPERTENSION

EASL; Session Title: Category 02b: Cirrhosis and its complications: Clinical aspects


Presentation Date: 31 MAR, 2011

LIVER RELATED EVENTS AND SURVIVAL IN PATIENTS WITH COMPENSATED HCV CIRRHOSIS: THE ROLE OF SUSTAINED VIROLOGICAL RESPONSE TO PEG-IFN BASED THERAPY AND PORTAL HYPERTENSION

V. Calvaruso1*, V. Di Marco1, D. Ferraro2, P. Pizzillo2, G. Alaimo1, A. Craxì1

1Gastroenterology and Hepatology, 2Igiene e Microbiologia, University of Palermo, Palermo, Italy. *vcalvaruso@libero.it

Background and aim: To assess the virological and disease factors associated to liver related events and survival in patients with compensated HCV cirrhosis treated with interferon based therapy.

Patients and methods: A cohort of 425 patients with Child-A HCV cirrhosis (mean age 58.0±8.5 years, 61.9% males; 87.1% infected by HCV-Genotype1 and 12.9% by Genotype2/Genotype3; 52.8% with esophageal varices, 27.5% with diabetes) received interferon-based antiviral treatment.

Sustained Virological Response(SVR) was defined as HCV-RNA negative at 6th month of follow-up. All patients underwent ultrasound scan every 6 months and endoscopy were repeated every 2 years.

Results: Overall SVR was 23.8% (17.6% in Genotype 1 patients vs 65.5% in Genotype2/Genotype 3 patients).

During a median follow-up of 48 months, 77 patients (18.1%) developed liver decompensation, 50 patients (11.8%) had hepatocellular carcinoma (HCC) and 55 patients(12.9%) died for liver events.

By Log-Rank test presence of esophageal varices (EV) was statistically associated to an higher occurrence of liver decompensation (p< 0.001) and with mortality liver related (p=0.009), but not with development of HCC (p=0.07).

The absence of SVR was associated with an higher rate of liver decompensation(p< 0.001), HCC(p< 0.001) and mortality(p=0.001).By Cox regression analysis, albumin (OR:0.61, CI95%:0.37-0.98; p=0.043), Bilirubin (OR:1.50, CI95%: 1.02-2.21; p=0.040), platelet count(OR:0.99, CI95%: 0.98-0.99; p=0.005) and SVR (OR:0.26, CI95%: 0.09-0.72; p=0.009) were independently associated with mortality. Adding decompensation and HCC development to the model these two variables became the unique factors independently associated to mortality liver related (OR:4.05, CI95%: 2.27-7.22; p< 0.001) and (OR:3.80, CI95%: 2.21-6.55; p< 0.001) respectively.

Conclusion: In patients with compensated HCV-cirrhosis, the presence of esophageal varices is associated with higher rate of decompensation and mortality but not with HCC occurrence.

SVR is a favourable factor of free-of-event survival by univariate analysis but only the liver events occurrence is independently associated to mortality. Development of HCC doesn't act only as a decompensation hastener but it results independently associated to mortality.

http://www1.easl.eu/easl2011/program/Posters/Abstract29.htm