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Complications and competing risks of death in compensated viral cirrhosis (ANRS CO12 CirVir prospective cohort)

Jean-Claude Trinchet 1 Valérie Bourcier 1 Cendrine Chaffaut Mohand Ait Ahmed Setty Allam Patrick Marcellin 2 Dominique Guyader 3 Stanislas Pol 4 Dominique Larrey 5, 6 Victor de Lédinghen Denis Ouzan Fabien Zoulim 7, 8 Dominique Roulot 9 Albert Tran 10, 11 Jean-Pierre Bronowicki 12, 13 Jean-Pierre Zarski 14 Odile Goria 15 Paul Calès 16 Jean-Marie Peron 17 Laurent Alric 18 Marc Bourlière 19 Philippe Mathurin 20 Jean-Frederic Blanc 21, 22 Armand Abergel 23 Lawrence Serfaty 24 Ariane Mallat 25, 26 Jean-Didier Grangé Catherine Buffet 27 Yannick Bacq 28 Claire Wartelle Thong Dao 29, 30 Yves Benhamou 31 Christophe Pilette Christine Silvain 32 Christos Christidis Dominique Capron 33 Gérard Thiefin Sophie Hillaire Vincent Di Martino Pierre Nahon 34, 35 Sylvie Chevret 36
Abstract : Unlabelled - Various critical events, liver related or not, occur in patients with compensated cirrhosis, but their respective burden remains to be prospectively assessed. The aim of this prospective cohort study involving 35 French centers was to capture the whole spectrum of complications occurring in compensated viral cirrhosis (VC) using competing risks analyses. Inclusion criteria were: histologically proven cirrhosis resulting from hepatitis C virus (HCV) or hepatitis B virus (HBV); Child-Pugh A; and no previous hepatic complications. The cohort was considered as a multistate disease model, cumulative incidences (CumIs) of events were estimated in a competing risks framework. A total of 1,654 patients were enrolled from 2006 to 2012 (HCV, 1,308; HBV, 315; HCV-HBV, 31). During a median follow-up of 34 months, at least one liver nodule was detected in 271 patients, confirmed as hepatocellular carcinoma (HCC) in 128 (4-year cumI: 10.5%) and cholangiocarcinoma in 3. HCC incidence was higher in HCV (4-year cumI: 11.4% vs. 7.4%; P = 0.05). HCC fulfilled Milan criteria in 79.3%, leading to curative treatment in 70.4%. Liver decompensation occurred more frequently in HCV patients (4-year cumI: 10.8% vs. 3.6%; P = 0.0004). Virological eradication/control was achieved in 34.1% of HCV and 88.6% of HBV patients and was associated with a marked decrease in HCC, decompensation, and bacterial infection incidences. Survival was shorter in HCV patients (4-year cumI: 91.6% vs. 97.2%; P = 0.0002). Death (n = 102; missing data: 6) was attributed to liver disease in 48 (47%; liver cancer: n = 18; miscellaneous, n = 30) and extrahepatic causes in 48 (47%; bacterial infection: n = 13; extrahepatic cancers: n = 10; cardiovascular events: n = 5; miscellaneous, n = 20). Conclusion - After 3 years of follow-up, extrahepatic events still explained half of deaths in patients with compensated VC. A strong decrease in complications was linked to virological eradication/control.
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Submitted on : Friday, September 18, 2015 - 1:50:24 PM
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Jean-Claude Trinchet, Valérie Bourcier, Cendrine Chaffaut, Mohand Ait Ahmed, Setty Allam, et al.. Complications and competing risks of death in compensated viral cirrhosis (ANRS CO12 CirVir prospective cohort). Hepatology, Wiley-Blackwell, 2015, 62 (3), pp.737--750. ⟨10.1002/hep.27743⟩. ⟨hal-01201948⟩



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