Hamish Innes1, Scott McDonald2, Peter Hayes3, John F Dillon4, Sam Allen5, David Goldberg2, Peter R Mills6, Stephen T Barclay7, David Wilks8, Heather Valerio2, Ray Fox9, Diptendu Bhattacharyya10, Nicholas Kennedy11, Judith Morris12, Andrew Fraser13, Adrian Stanley7, Peter Bramley14, Sharon J Hutchinson2. 1. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. Electronic address: hamish.innes@nhs.net. 2. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK. 3. Royal Infirmary Edinburgh, Edinburgh, UK. 4. Ninewells Hospital and Medical School, Dundee, UK. 5. University Hospital, Crosshouse, UK. 6. Gartnavel General Hospital, Glasgow, UK. 7. Glasgow Royal Infirmary, Glasgow, UK. 8. Western General Hospital, Edinburgh, UK. 9. The Brownlee Centre, Glasgow, UK. 10. Kirkcaldy Hospital, Fife, UK. 11. Monklands Hospital, Lanarkshire, UK. 12. Southern General Hospital, Glasgow, UK. 13. Aberdeen Royal Infirmary, Aberdeen, UK. 14. Stirling Royal Infirmary, Stirling, UK.
Abstract
BACKGROUND & AIMS: The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. METHODS: Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. RESULTS: We identified 1824 patients, followed on average for 5.2years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% confidence interval (CI): 1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI: 12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95% CI: 4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI: 0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population. LAY SUMMARY: Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol and injecting drug use were associated with a higher mortality risk. Copyright Â
BACKGROUND & AIMS: The number of people living with previous hepatitis C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. METHODS: Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised mortality ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. RESULTS: We identified 1824 patients, followed on average for 5.2years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% confidence interval (CI): 1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver cancer (SMR: 23.50; 95% CI: 12.23-45.16), and death due to drug-related causes (SMR: 6.58, 95% CI: 4.15-10.45). Together these two causes accounted for 66% of the total excess death observed. All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (SMR: 0.70; 95% CI: 0.41-1.18) CONCLUSIONS: Mortality in Scottish SVR patients is higher overall than the general population. The excess was driven by death from drug-related causes and liver cancer. Health risk behaviours emerged as important modifiable determinants of mortality in this population. LAY SUMMARY:Patients cured of hepatitis C through treatment had a higher mortality rate overall than the general population. Most of the surplus mortality was due to drug-related causes and death from liver cancer. A history of heavy alcohol and injecting drug use were associated with a higher mortality risk. Copyright Â
Authors: Alessio Strazzulla; Rosa Maria Rita Iemmolo; Ennio Carbone; Maria Concetta Postorino; Maria Mazzitelli; Mario De Santis; Fabrizio Di Benedetto; Costanza Maria Cristiani; Chiara Costa; Vincenzo Pisani; Carlo Torti Journal: Hepat Mon Date: 2016-10-30 Impact factor: 0.660
Authors: Tea L Laursen; Thomas D Sandahl; Konstantin Kazankov; Jacob George; Henning Grønbæk Journal: World J Gastroenterol Date: 2020-06-14 Impact factor: 5.742