Digestive Diseases and Sciences

, Volume 62, Issue 1, pp 76–83 | Cite as

Role of Non-hepatic Medical Comorbidity and Functional Limitations in Predicting Mortality in Patients with HCV

  • Yamini Natarajan
  • Donna L. White
  • Hashem B. El-Serag
  • David Ramsey
  • Peter Richardson
  • Jill Kuzniarek
  • Richa Shukla
  • Aylin Tansel
  • Fasiha Kanwal
Original Article



Medical comorbidities and functional status limitations are determinants of mortality in many chronic diseases. The extent to which survival in the rapidly aging cohort of patients with HCV is affected by these competing causes of mortality remains unclear.


We sought to determine the effect of medical/functional comorbidities on survival after adjusting for liver disease severity in a cohort of patients with HCV infection.


We prospectively recruited consecutive patients from an HCV clinic 2009–2014. We calculated an index of survival (Schonberg Index, SI) based on age, gender, medical comorbidities, and functional status variables. We defined cirrhosis with the FibroSure test (F3/4–F4). We used multivariable Cox modeling to assess association between functional/survival measure and survival after adjustment for severity of liver disease.


The cohort consisted of 1052 HCV patients. The average age was 56.8 years; 36 % had cirrhosis. The mean SI was 8.2 (SD = 2.7). During a mean follow-up of 5610 person-years, 102 (9.7 %) patients died. In unadjusted analysis, higher baseline SI predicted mortality (HR 1.17; 95 % CI 1.09–1.25). SI similarly predicted mortality in cirrhotic patients (HR 1.23, 95 % CI 1.13–1.34) and non-cirrhotic patients (HR 1.21, 95 % CI 1.08–1.36). This did not change after adjusting for age, drug use, or coronary artery disease.


Comorbidities and functional limitations predict higher mortality in patients with HCV; this relationship is independent of cirrhosis. Use of general prognostic indices may help identify HCV patients at high risk for mortality, which could further guide clinical care in a manner not achievable with assessment of liver disease alone.


Epidemiology Hepatology Hepatitis C Comorbidity Prognosis Natural history Mortality 



Schonberg Index


Body mass index


Confidence interval


Hepatitis C virus


Hepatocellular carcinoma


Odds ratio


Hazard ratio


Proportional hazards



This research was funded in part by the U.S. Department of Veterans Affairs (CSR&D Merit Review H-22934, PI: El-Serag), and the Houston Veterans Affairs Health Services Research Center of Innovations (CIN13-413). Drs. El-Serag’s and White’s effort was supported in part by the National Institute of Diabetes Digestive and Kidney Diseases (K01 DK081736 and K24 DK04-107, respectively).

Author’s contributions

Yamini Natarajan—Collaborated in study design, performed the research, collected and analyzed the data, wrote the manuscript. Donna L. White—Collaborated in study design, wrote the manuscript. Hashem B El-Serag—Collaborated in study design, wrote the manuscript. David Ramsey—Collaborated in study design, collected and analyzed data. Peter Richardson—Collected and analyzed data. Jill Kuzniarek—Collaborated in study design, collected data. Richa Shukla—Performed the research, collected the data. Aylin Tansel—Performed the research, collected the data. Fasiha Kanwal—Collaborated in study design, analyzed the data, wrote the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer Science+Business Media New York (Outside the USA) 2016

Authors and Affiliations

  • Yamini Natarajan
    • 1
  • Donna L. White
    • 1
    • 2
    • 3
    • 4
    • 5
  • Hashem B. El-Serag
    • 1
    • 2
    • 3
    • 4
  • David Ramsey
    • 2
  • Peter Richardson
    • 2
  • Jill Kuzniarek
    • 2
  • Richa Shukla
    • 1
  • Aylin Tansel
    • 1
  • Fasiha Kanwal
    • 1
    • 2
    • 3
    • 4
  1. 1.Section of Gastroenterology and HepatologyMichael E. DeBakey VA Medical Center and Baylor College of MedicineHoustonUSA
  2. 2.Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt)Michael E. DeBakey VA Medical Center and Baylor College of MedicineHoustonUSA
  3. 3.Texas Medical Center Digestive Disease CenterHoustonUSA
  4. 4.Dan L. Duncan Cancer Center at Baylor College of MedicineHoustonUSA
  5. 5.Center for Translational Research on Inflammatory Diseases (CTRID)Michael E. DeBakey Veterans Affairs Medical CenterHoustonUSA

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