Advertisement

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

Abstract

Background

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.

Aim

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.

Methods

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.

Results

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.

Discussion

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.

Keywords

Epidemiology Hepatology Hepatitis C Comorbidity Prognosis Natural history Mortality 

Abbreviations

SI

Schonberg Index

BMI

Body mass index

CI

Confidence interval

HCV

Hepatitis C virus

HCC

Hepatocellular carcinoma

OR

Odds ratio

HR

Hazard ratio

PH

Proportional hazards

Notes

Acknowledgments

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.

References

  1. 1.
    Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med. 1999;341:556–562.CrossRefPubMedGoogle Scholar
  2. 2.
    Tetsche MS, Dethlefsen C, Pedersen L, Sorensen HT, Norgaard M. The impact of comorbidity and stage on ovarian cancer mortality: a nationwide Danish cohort study. BMC Cancer. 2008;8:31.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fried LP, Kronmal RA, Newman AB, et al. Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA. 1998;279:585–592.CrossRefPubMedGoogle Scholar
  4. 4.
    Carey EC, Walter LC, Lindquist K, Covinsky KE. Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med. 2004;19:1027–1033.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Saliba D, Elliott M, Rubenstein LZ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49:1691–1699.CrossRefPubMedGoogle Scholar
  6. 6.
    Eng JA, Clough-Gorr K, Cabral HJ, Silliman RA. Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability. J Am Geriatr Soc. 2015;63:757–762.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Szabo SM, Samp JC, Walker DR, et al. Liver-specific case fatality due to chronic hepatitis C virus infection: a systematic review. Ann Hepatol. 2015;14:618–630.Google Scholar
  8. 8.
    Guiltinan AM, Kaidarova Z, Custer B, et al. Increased all-cause, liver, and cardiac mortality among hepatitis C virus-seropositive blood donors. Am J Epidemiol. 2008;167:743–750.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Duberg A-S, Törner A, Davidsdóttir L, et al. Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study. J Viral Hepat. 2008;15:538–550.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee M-H, Yang H-I, Lu S-N, et al. Chronic hepatitis C virus infection increases mortality from hepatic and extrahepatic diseases: a community-based long-term prospective study. J Infect Dis. 2012;206:469–477.CrossRefPubMedGoogle Scholar
  11. 11.
    Omland LH, Jepsen P, Krarup H, et al. Increased mortality among persons infected with hepatitis C virus. Clin Gastroenterol Hepatol. 2011;9:71–78.CrossRefPubMedGoogle Scholar
  12. 12.
    White DL, Tavakoli-Tabasi S, Kuzniarek J, Pascua R, Ramsey DJ, El-Serag HB. Higher serum testosterone is associated with increased risk of advanced hepatitis C-related liver disease in males. Hepatology. 2012;55:759–768.CrossRefPubMedGoogle Scholar
  13. 13.
    Sohn M-W, Arnold N, Maynard C, Hynes DM. Accuracy and completeness of mortality data in the Department of Veterans Affairs. Popul Health Metr. 2006;4:2.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey. J Gen Intern Med. 2009;24:1115–1122.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older. J Am Geriatr Soc. 2011;59:1444–1451.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Drazer MW, Prasad SM, Huo D, et al. National trends in prostate cancer screening among older American men with limited 9-year life expectancies: evidence of an increased need for shared decision making. Cancer. 2014;120:1491–1498.CrossRefPubMedGoogle Scholar
  17. 17.
    13th Annual meeting of the society for the study of reproduction. Portland, Oregon, August 2–5, 1997. Abstracts. Biol Reprod. 1997;56:83–243.Google Scholar
  18. 18.
    Kerr KF, Wang Z, Janes H, McClelland RL, Psaty BM, Pepe MS. Net reclassification indices for evaluating risk prediction instruments: a critical review. Epidemiology. 2014;25:114–121.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bernacki REBS. Communication about serious illness care goals a review and synthesis of best practices. JAMA. 2014;174:1994–2003.Google Scholar
  20. 20.
    Jepsen P, Vilstrup H, Lash TL. Development and validation of a comorbidity scoring system for patients with cirrhosis. Gastroenterology. 2014;146:147–156. (quiz e15–e16).CrossRefPubMedGoogle Scholar
  21. 21.
    Sharabiani MTA, Aylin P, Bottle A. Systematic review of comorbidity indices for administrative data. Med Care. 2012;50:1109–1118.CrossRefPubMedGoogle Scholar

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

Personalised recommendations