Which patients with hepatitis C develop liver complications?

To identify variables that are independent predictors of adverse outcomes i n chronic hepatitis C, we analyzed a cohort of 455 patients followed for a median of 4.7 years. Associations were sought between demographic and behav ioral factors, hepatitis C virus (HCV) genotype, liver histology and liver tests at entry, and development of liver complications, hepatocellular carc inoma (HCC), hepatic transplantation and liver-related death. Independent p redictors were identified by multivariate analysis. The following were asso ciated with a significantly higher rate of liver complications: age; birth in Asia, Europe, Mediterranean region, or Egypt; transmission by blood tran sfusion or sporadic cases; HCV genotypes 1b and 4 (compared with 1/1a); fib rosis stage 3 or 4 (cirrhosis); serum albumin; bilirubin; prothrombin time; and cr-fetoprotein. However, the only independent predictors of liver-rela ted complications were sporadic transmission (P < .001), advanced fibrosis (P = .004), and low albumin (P < .001). The corresponding independent risk factors for HCC were male gender (P = .07), sporadic transmission (P < .001 ), and albumin (P < .001); bilirubin (P = .02) was an additional predictor of transplantation or liver-related death. It is concluded that only patien ts with advanced hepatic fibrosis or cirrhosis, are at risk of developing h epatic complications of chronic hepatitis C during 5-year follow-up. Among such patients, abnormalities in serum albumin, bilirubin, or prothrombin ti me indicate a high probability of complications. Patients without definite risk factors for HCV (sporadic cases) are at higher risk of complications, possibly because of interaction between older age, duration of infection, c ountry of birth, and HCV genotypes 1b and 4.