1. Simplified follow-up of patients with mild chronic hepatitis C in areas with limited access to antiviral therapy
- Author
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Xavier Forns, Sabela Lens, María-Carlota Londoño, Zoe Mariño, Martin Bonacci, Anna Pocurull, Ferran Torres, Sergio Rodríguez-Tajes, and Concepció Bartres
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Antiviral Agents ,Severity of Illness Index ,Gastroenterology ,Limited access ,Chronic hepatitis ,Predictive Value of Tests ,Fibrosis ,Liver stiffness ,Internal medicine ,medicine ,Humans ,In patient ,Aspartate Aminotransferases ,Retrospective Studies ,Hepatology ,Platelet Count ,business.industry ,Disease progression ,Antiviral therapy ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,Survival Analysis ,Spain ,Disease Progression ,Elasticity Imaging Techniques ,Female ,business ,Biomarkers ,Follow-Up Studies - Abstract
In some areas of the world, antiviral therapy for chronic hepatitis C (CHC) is not available for all patients. The optimal interval for liver stiffness measures (LSM) and noninvasive scores to assess fibrosis progression has not been studied. We evaluated the usefulness of consecutive LSM, APRI, FIB-4 and Forns scores to predict disease progression.Patients with CHC and at least two annual LSM within 3 years were followed for a minimum of 5 years. Noninvasive scores were assessed. Evolution of LSM and scores were expressed as change/year (Delta).623 non-cirrhotic patients were included. Median baseline LSM was 6.6 kPa (IQR 5.4-8.4). During a median follow-up of 6 years, 61(9.7%) patients developed cirrhosis. Baseline LSM ≥ F2 and Forns ≥ 6.9 were the main predictors of cirrhosis (C-index 0.97). The addition of Delta variables did not improve its prediction. In patients with mild fibrosis (F0-1), progression to ≥F2 occurred in 80 (23%) within the first 3 years. Baseline BMI ≥ 24 kg/mBaseline LSM and Forns are highly predictive of cirrhosis development. In patients with mild CHC, BMI 24 and LSM 5.9, the likelihood of progression is very low, allowing for a significant spacing of noninvasive assessments over time.
- Published
- 2019
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