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• W1154745530 abstract "Background: Patients with cirrhosis have lower response rates to the current standard treatments for hepatitis C and are at greater risk of clinical decompensation (CD) with continued infection. The risk of CD should be considered when treatment decisions for HCV are made. CD is associated with portal hypertension (PH). Because the assessment of PH requires invasive studies not widely available in the US, there is need for non-invasive markers. Abnormal hematological indices (HI), both thrombocytopenia (TH) and leukopenia (LE) have been associated with clinically significant PH. The purpose of this study is to determine if baseline HI can be used to predict decompensation prior to anti-viral therapy in a cohort of patients who did not respond to treatment. Methods: The study was a retrospective individual chart review on 427 patients identified in the Partners Research Data Repository who received HCV treatment. Inclusion criteria: .18 years, therapy with Peginterferon and Ribavirin, compensated liver disease and Metavir score of 4 on biopsy. Exclusion criteria: early stage fibrosis, post-liver transplant, HIV co-infection, untreated HCV. Baseline characteristics including HI were collected. Abnormal HI was defined as TH , 150,000, LE, 4,000 and Anemia, 13.5 g/dl (male) 11.5 g/dl (female).The primary outcome was long term occurrence of first CD defined by new ascites, jaundice, encephalopathy or variceal hemorrhage after completion of HCV therapy. Student's t test was used to compare means, Fisher exact test to compare proportions, multivariate logistic regression to identify predictors for CD. Results: 153 patients met criteria. 37 (24 %) patients had an SVR. Among the 116 patients who did not respond to therapy, at baseline, 40 (34 %) had TH, 24 (21 %) had LE and 38 (33 %) had anemia. CD occurred in 35 (30%). None of the SVR patients had CD. Among decompensation events, jaundice occurred in 74 %, encephalopathy in 54 %, ascites occurred in 51 %, and variceal hemorrhage in 6 %. Univariate analysis showed baseline TH OR 13.8 ( p-value , 0.001 ) and LE OR 3.8 (p-value = 0.006) ) were associated with CD. Anemia at baseline OR 1.6 (p-value = 0.27) was not associated with CD and not considered in further analysis. On multivariate analysis controlled for baseline abnormal HI, TH and/or LE OR 10.3 (p-value , 0.001) and albumin OR 0.14 (p-value 0.001) predicted CD while age OR 1.00 (p-value 0.88) and MELD OR 1.02 (p-value 0.83) did not. The table shows the SVR and CD rates in patients with or without abnormal HI or albumin , 4.0 g/ dl in different combinations. Conclusion: Patients with abnormal HI at baseline who do not respond to anti-viral therapy have an increased risk for CD. Using the baseline albumin and HI, an assessment of SVR and CD rates should be considered when initiating antiviral therapy. Decompensation and SVR Among Different Pre-Treatment Patient Characteristics 81% Treatment Naive (124/153) ( * Albumin in g/dL, ¥ HI=Hematologic Indices)" @default.
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• W1154745530 date "2013-05-01" @default.
• W1154745530 modified "2023-09-25" @default.
• W1154745530 title "Sa1064 Baseline Hematologic Indices With Albumin Predict Clinical Decompensation in Patients With HCV Cirrhosis Who Do Not Respond to Antiviral Therapy" @default.
• W1154745530 doi "https://doi.org/10.1016/s0016-5085(13)63662-8" @default.
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