DETERMINANTS OF OUTCOME OF COMPENSATED HEPATITIS-C VIRUS-RELATED CIRRHOSIS

The aim of this study was to assess the incidence of decompensation (a scites, jaundice, variceal bleeding, and encephalopathy), hepatocellul ar carcinoma (HCC) and death or liver transplantation in patients with compensated hepatitis C virus (HCV)-related cirrhosis, taking into ac count the viral genotype and interferon (IFN) therapy Between 1989 and 1994, 668 patients with no clinical evidence of decompensation were r eferred to our department for liver biopsy because of positivity for a nti-HCV antibodies and elevated aminotransferase activity; 103 of thes e patients had cirrhosis. The median follow-up was 40 months. Fifty-ni ne patients were treated with IFN for a mean duration of 11 +/- 6 mont hs; 3 (5%) had a prolonged biochemical and virological response. Basel ine characteristics of IFN-treated and untreated patients were not sig nificantly different. HCV genotypes (InnoLiPa) were predominantly Ib ( 48%) and 3a (20%), During follow-up, complications of cirrhosis occurr ed in 26 patients, HCC in 11 patients, and decompensation not related to HCC in 19 patients. Sixteen patients died, 94% of liver disease. Th ree patients were transplanted for liver failure. The 4-year risk of H CC was 11.5% (annual incidence 3.3%) and that of decompensation was 20 %. Survival probability was 96% and 84% at 2 and 4 years, respectively . In multivariate analysis, the absence of IFN therapy was the only in dependent factor predictive both for HCC and decompensation. A low alb umin level at entry and the absence of IFN therapy were the two indepe ndent factors predictive of death or liver transplantation. Probabilit y of survival at 2 and 4 years was significantly different between IFN -treated and untreated patients (respectively 97% and 92% vs 95% and 6 3%, P < .0001). In conclusion, in patients with compensated HCV-relate d cirrhosis: 1) complications of cirrhosis are frequent, whatever the viral genotype; and 2) the severity of cirrhosis and the absence of IF N therapy are independently predictive of bad outcome.