Predicting Clinical and Histologic Outcomes Based on Standard Laboratory Tests in Advanced Chronic Hepatitis C

Marc G. Ghany, Anna S F Lok, James E. Everhart, Gregory T. Everson, William M. Lee, Teresa M. Curto, Elizabeth C. Wright, Anne M. Stoddard, Richard K. Sterling, Adrian M. Di Bisceglie, Herbert L. Bonkovsky, Chihiro Morishima, Timothy R. Morgan, Jules L. Dienstag

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Abstract

Background & Aims: Predictors of clinical outcomes and histologic progression among patients with chronic hepatitis C and advanced fibrosis are poorly defined. We developed statistical models to predict clinical and histologic outcomes in such patients. Methods: Baseline demographic, clinical, and histologic data from Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial participants were subjected to multivariate analyses to determine their ability to predict clinical outcomes (ascites, spontaneous bacterial peritonitis, Child-Turcotte-Pugh score ≥7 on 2 consecutive visits, variceal bleeding, hepatic encephalopathy, and liver-related death) and histologic outcome (≥2-point increase in Ishak fibrosis stage) during the 3.5 years of the trial. Results: Of 1050 randomized patients, 135 had 1 or more clinical outcomes a median of 23 (range, 1-45) months after randomization. Factors associated with a clinical outcome in multivariate analyses were higher aspartate aminotransferase/alanine aminotransferase ratio, lower albumin, lower platelet count, higher total bilirubin, and more advanced Ishak fibrosis score (P < .0001). The cumulative 3.5-year incidence of a clinical outcome was 2% in the lowest and 65% in the highest risk group. Of 547 patients without cirrhosis at baseline and at least 1 follow-up biopsy, 152 had a histologic outcome. Independent variables associated with a histologic outcome were higher body mass index, lower platelet count, and greater hepatic steatosis (P < .0001). Conclusions: In patients with chronic hepatitis C and advanced fibrosis, risk of clinical complications and fibrosis progression during 3.5 years can be predicted using baseline laboratory tests and histologic data. Our models may be useful in counseling patients and determining the frequency of monitoring.

Original languageEnglish (US)
Pages (from-to)136-146
Number of pages11
JournalGastroenterology
Volume138
Issue number1
DOIs
StatePublished - Jan 2010

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Chronic Hepatitis C
Fibrosis
Platelet Count
Multivariate Analysis
Aptitude
Hepatic Encephalopathy
Liver
Statistical Models
Hepatitis C
Random Allocation
Aspartate Aminotransferases
Peritonitis
Alanine Transaminase
Bilirubin
Ascites
Antiviral Agents
Counseling
Albumins
Body Mass Index
Demography

ASJC Scopus subject areas

  • Gastroenterology

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Ghany, M. G., Lok, A. S. F., Everhart, J. E., Everson, G. T., Lee, W. M., Curto, T. M., ... Dienstag, J. L. (2010). Predicting Clinical and Histologic Outcomes Based on Standard Laboratory Tests in Advanced Chronic Hepatitis C. Gastroenterology, 138(1), 136-146. https://doi.org/10.1053/j.gastro.2009.09.007

Predicting Clinical and Histologic Outcomes Based on Standard Laboratory Tests in Advanced Chronic Hepatitis C. / Ghany, Marc G.; Lok, Anna S F; Everhart, James E.; Everson, Gregory T.; Lee, William M.; Curto, Teresa M.; Wright, Elizabeth C.; Stoddard, Anne M.; Sterling, Richard K.; Di Bisceglie, Adrian M.; Bonkovsky, Herbert L.; Morishima, Chihiro; Morgan, Timothy R.; Dienstag, Jules L.

In: Gastroenterology, Vol. 138, No. 1, 01.2010, p. 136-146.

Research output: Contribution to journalArticle

Ghany, MG, Lok, ASF, Everhart, JE, Everson, GT, Lee, WM, Curto, TM, Wright, EC, Stoddard, AM, Sterling, RK, Di Bisceglie, AM, Bonkovsky, HL, Morishima, C, Morgan, TR & Dienstag, JL 2010, 'Predicting Clinical and Histologic Outcomes Based on Standard Laboratory Tests in Advanced Chronic Hepatitis C', Gastroenterology, vol. 138, no. 1, pp. 136-146. https://doi.org/10.1053/j.gastro.2009.09.007
Ghany, Marc G. ; Lok, Anna S F ; Everhart, James E. ; Everson, Gregory T. ; Lee, William M. ; Curto, Teresa M. ; Wright, Elizabeth C. ; Stoddard, Anne M. ; Sterling, Richard K. ; Di Bisceglie, Adrian M. ; Bonkovsky, Herbert L. ; Morishima, Chihiro ; Morgan, Timothy R. ; Dienstag, Jules L. / Predicting Clinical and Histologic Outcomes Based on Standard Laboratory Tests in Advanced Chronic Hepatitis C. In: Gastroenterology. 2010 ; Vol. 138, No. 1. pp. 136-146.
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AU - Curto, Teresa M.

AU - Wright, Elizabeth C.

AU - Stoddard, Anne M.

AU - Sterling, Richard K.

AU - Di Bisceglie, Adrian M.

AU - Bonkovsky, Herbert L.

AU - Morishima, Chihiro

AU - Morgan, Timothy R.

AU - Dienstag, Jules L.

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