New Clinical Score Can Stratify Hepatitis Mortality Risk

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HepCom score demonstrated good calibration and discrimination for predicting both 1- and 2-year mortality outcomes.
HepCom score demonstrated good calibration and discrimination for predicting both 1- and 2-year mortality outcomes.

A hepatitis risk-prediction score comprised of liver function markers, the Charlson Comorbidity Index, and age can independently stratify antiviral-treated hepatitis C (HCV) patients according to their 1- and 2-year mortality risk, according to findings published in the Journal of Hepatology.

In this study, investigators prospectively assessed 1891 patients infected with HCV from a total of 14 hospitals receiving direct-acting antiviral therapy for up to 2 years or until death, whichever came first. Researchers evaluated the utility of the HepCom Index, which consists of age, albumin and bilirubin levels, Charlson Index, and alanine aminotransferase (ALT), for predicting mortality.

During the 2-year duration of this study, approximately 5.4% (n=102) of patients had died, with mortality occurring in 3.4% of patients ≤1 year following enrollment.

Independent predictors for 1-year mortality in this patient cohort included age (hazard ratio [HR] 1.06 [95% CI 1.02-1.11]; P =.005), albumin levels (HR 0.18 [95% CI, 0.09-0.37]; P =.0001), bilirubin (HR 1.39 [95% CI, 1.11-1.75]; P =.004), Charlson Index (HR 1.55 [95% CI, 1.29-1.86]; P =.0001), and international normalized ratio (INR) (HR 3.49 [95% CI, 1.36-8.97]; P =.010), all of which comprise the HepCom score.

The HepCom score demonstrated good calibration and discrimination (C-statistics 0.90) for predicting both 1- and 2-year mortality outcomes.

The researchers suggested that the relatively short follow-up of 2 years contributed to the low absolute mortality rate in this cohort. Additional studies may be necessary to determine more conclusive findings on the associations between direct-acting antiviral therapy with the HepCom score and mortality in patients with HCV.

Despite the study's inherent limitations, the findings demonstrate the clinical utility of the HepCom score “to stratify better HCV patients receiving direct-acting antiviral therapy regarding prognosis, beyond of the eradication of the virus.”

Reference

Ampuero J, Jimeno C, Quiles R, et al. Impact of comorbidities on patients outcomes after interferon-free therapy-induced viral eradication in hepatitis [published online December 27, 2017]. J Hepatol. doi:10.1016/j.jhep.2017.12.019

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