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28-06-2011 | General practice | Article

All-cause mortality more than doubled among HCV-infected patients

Abstract

Free abstract

MedWire News Study findings show that all-cause mortality in people chronically infected with hepatitis C virus (HCV) is more than twice as high as that in HCV-negative individuals, suggesting that the former patient population has a higher risk for death even after accounting for liver-related morbidity.

"This should reinforce the importance of preventive measures, particularly among individuals at risk for acquiring the disease, as well as early diagnosis, and improving access to care for those already infected, even in the absence of liver disease," said lead study author Samer El-Kamary (University of Maryland, Baltimore, USA).

The researchers assessed HCV status and associated mortality in a sample of 9378 individuals aged 17-59 years who were enrolled in the Third National Health and Nutrition Examination Survey (NHANES III) during 1988-1994 and followed-up until 2006.

Over a median follow-up period of 14.8 years there were 614 deaths, of which 27 (4.4%) were due to liver-related causes such as malignant liver neoplasms, viral hepatitis, alcoholic liver disease, and other chronic liver diseases.

In total, 44 of the 203 chronically HCV-infected patients died, nine from liver-related complications. The remaining deaths were linked to HIV, other infectious diseases, cancer, cardiovascular disease, diabetes, and other causes.

Compared with a HCV-negative status, chronic HCV infection was linked to a 2.37-fold higher all-cause mortality rate ratio (MRR), a 26.4-fold higher liver-related MRR, and 1.79-fold higher non-liver related MRR, after adjusting for age, gender, demographics, lifestyle behaviors, body mass index, comorbidities, viruses and liver function biomarkers.

Extrapolating from their findings, the researchers estimate that there were 2.46 million US adults aged 17-59 years with chronic HCV infection, resulting in an estimated 31,163 deaths per year, of which 57.8% were attributable to HCV. Furthermore, there were an estimated 9569 liver-related deaths per year, of which 96.2% were linked to HCV.

The study also suggested that individuals who were anti-HCV positive or chronically infected with HCV were significantly more likely to be male, non-Hispanic Black, single, high-school dropouts, current smokers, or HIV positive than those who were anti-HCV negative.

Writing in the journal Clinical Infectious Diseases, the team concludes: "Given these findings, and the greater availability and affordability of various HCV testing methods, perhaps increased testing, earlier therapy, and closer monitoring of all HCV-positive individuals, particularly those with non-liver-related morbidities, should be considered by healthcare providers."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Ingrid Grasmo

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