BACKGROUND & AIMS: Liver stiffness can be measured, non-invasively, to assess liver fibrosis in patients with chronic hepatitis C. In patients with chronic liver diseases, level of fibrosis predicts liver-related complications and survival. We evaluated the abilities of liver stiffness, results from non-invasive tests for fibrosis, and liver biopsy analyses to predict overall survival or survival without liver-related death with a 5-year period.
METHODS: In a consecutive cohort of 1457 patients with chronic hepatitis C, we assessed fibrosis, and on the same day, liver stiffness, performed the non-invasive tests of fibrosis (FibroTest, the platelet ratio index, FIB-4), and analyzed liver biopsy samples. We analyzed data on death, liver-related death, and liver transplantation collected over a 5 year follow-up period.
RESULTS: At 5 years, 77 patients had died (39 liver-related deaths) and 16 patients had undergone liver transplantation. Overall survival was 91.7% and survival without liver-related death was 94.4%. Survival was significantly decreased among patients diagnosed with severe fibrosis, regardless of the non-invasive method of analysis. All methods were able to predict shorter survival times in this large population; liver stiffness and results of the FibroTest had higher predictive values. Patient outcomes worsened as liver stiffness and FibroTest values increased. The prognostic values of stiffness (P<0.0001) and FibroTest results (P<0.0001) remained after they were adjusted for treatment response, patient age, and estimates of necroinflammatory grade.
CONCLUSION: Non-invasive tests for liver fibrosis (measurement of liver stiffness or FibroTest) can predict 5-year survival of patients with chronic hepatitis C. These tools might help physicians to determine prognosis at earlier stages and discuss specific treatments, such as liver transplantation.