Long-term follow-up of chronic hepatitis C in patients diagnosed at a tertiary-care center

Background/Aims: The natural history of chronic hepatitis C (HCV) is not co mpletely understood. This study was aimed to evaluate the long-term outcome of the disease over a prolonged period of time and to identify factors ass ociated with progression. Methods: One hundred and sixteen patients with non-cirrhotic chronic non-A, non-B hepatitis consecutively diagnosed at a tertiary hospital between 197 1 and 1977 were followed until December 1998 or until death. Patients with significant alcohol intake were excluded from the study. Variables obtained at the time of diagnosis, including epidemiological, clinical, laboratory, and histological data were recorded to determine risk factors associated w ith the development of liver cirrhosis and hepatic decompensation. Results: Based on complete follow-up data, the development of liver cirrhos is and hepatic decompensation was evaluated in 94 and 114 of the 116 patien ts, respectively. Thirty-seven (39.3%) of 94 patients developed liver cirrh osis; an aspartate aminotransferase (AST) value higher than 70 IU/L was ass ociated with development of cirrhosis (odds ratio (OR) 4.22, 95% CI 1.3-13. 8). Hepatic decompensation occurred in 12 (10.5%) of 114 patients, its cumu lative probability being 2.8% at 10 years, 5.2% at 15 years and 19.8% at 20 years. The only factor independently associated to the development of hepa tic decompensation was the presence of fibrosis (stage 2 or 3) in the initi al liver biopsy (OR 4.1, IC 95% 1.22-13.9). Liver-related death occurred on ly in seven (6%) of 114 patients. In comparison with the 116 patients diagn osed in the 1970's, patients with chronic hepatitis C diagnosed in 1999 wer e younger, more often asymptomatic, had lower AST and alanine aminotransfer ase (ALT) values and had significantly lower grade and stage histological s cores. Conclusions: In summary, chronic hepatitis C had a high rate of progression to liver cirrhosis over a prolonged follow-up. However, this might be rela ted to the fact that two decades ago the diagnosis was made at a significan tly more advanced stage of the disease. Patients at high risk of progressio n can be identified by biochemical and histological variables at the time o f diagnosis. (C) 2001 European Association for the Study of the Liver. Publ ished by Elsevier Science B.V. All rights reserved.