Case Control Study
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World J Gastroenterol. May 14, 2014; 20(18): 5519-5526
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5519
Risk factors for liver-related mortality in chronic hepatitis C patients: A deceased case-living control study
Qing-Lei Zeng, Guo-Hua Feng, Ji-Yuan Zhang, Yan Chen, Bin Yang, Hui-Huang Huang, Xue-Xiu Zhang, Zheng Zhang, Fu-Sheng Wang
Qing-Lei Zeng, Guo-Hua Feng, Xue-Xiu Zhang, Fu-Sheng Wang, The Institute of Translational Hepatology, Beijing 302 Hospital, Peking University Health Science Center, Beijing 100039, China
Ji-Yuan Zhang, Zheng Zhang, Fu-Sheng Wang, Research Center for Biological Therapy, Beijing 302 Hospital, Beijing 100039, China
Yan Chen, Center of Therapeutic Research for Hepatocellular Carcinoma, Beijing 302 Hospital, Beijing 100039, China
Bin Yang, Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, China
Hui-Huang Huang, Department of Intensive Care Unit, Beijing 302 Hospital, Beijing 100039, China
Author contributions: Zeng QL, Feng GH and Zhang JY contributed equally to this work; Zeng QL designed and performed the study and wrote the manuscript; Feng GH and Zhang JY performed the study and were involved in editing the manuscript; Chen Y, Yang B, Huang HH, Zhang XX and Zhang Z performed the study and statistical analysis and interpreted the data; Wang FS designed the study, acquired the clinical data and revised and edited the manuscript.
Supported by National Natural Science Foundation of China, No. 81302593, No. 81271848 and No. 81101589; the Grant of Beijing Nova Program of China, No. Z121107002512071; the National Key Basic Research Program of China, No. 2009CB522507; and the National Grand Program on Key Infectious Disease, No. 2009ZX10005-017 and No. 2012ZX10002007
Correspondence to: Fu-Sheng Wang, MD, PhD, The Institute of Translational Hepatology, Beijing 302 Hospital, Peking University Health Science Center, Fengtai District, Beijing 100039, China. fswang302@163.com
Telephone: +86-10-66933332 Fax: +86-10-66933332
Received: November 29, 2013
Revised: January 9, 2014
Accepted: February 26, 2014
Published online: May 14, 2014
Processing time: 165 Days and 16 Hours
Abstract

AIM: To investigate the risk factors for liver-related mortality in chronic hepatitis C (CHC) patients.

METHODS: All deceased CHC inpatient data were collected from the Beijing 302 Hospital clinical database, which includes more than 8250 CHC inpatients during the period from 2002 to 2012. The controls were matched to cases by age (± 2 years), sex and date of hospital admission (within the same year). Potential risk factors were included for the evaluation, and odds ratios (OR) and 95%CI were estimated using univariate (unadjusted) and multivariate (adjusted OR, AOR) conditional logistic regression. All statistical tests were two-sided. P values < 0.05 were considered statistically significant.

RESULTS: Based on examinations of 144 CHC-related deceased cases and 576 controls, we found that antiviral therapy with interferon-α was associated with a 47% decrease in the risk of hepatic mortality (AOR = 0.53, 95%CI: 0.28-0.99, P = 0.048). Additionally, the initial diagnostic stage of the disease (AOR = 2.89, 95%CI: 1.83-4.56 and P < 0.001 for liver cirrhosis/AOR = 8.82, 95%CI: 3.99-19.53 and P < 0.001 for HCC compared with CHC), diabetes (AOR = 2.35, 95%CI: 1.40-3.95, P = 0.001), hypertension (AOR = 1.76, 95%CI: 1.09-2.82, P = 0.020), alcohol consumption (AOR = 1.73, 95%CI: 1.03-2.81, P = 0.037) and HBsAg positivity (AOR = 22.28, 95%CI: 5.58-89.07, P < 0.001) were associated with a significant increase in the risk of liver-related mortality in CHC patients.

CONCLUSION: This study indicates that interferon-α treatment, the stage at the initial diagnosis of the disease and comorbidities are all independent risk factors for liver-related mortality in CHC patients.

Keywords: Hepatitis C virus; Chronic hepatitis C; Risk factor; Mortality; Case control study

Core tip: Many previous studies have suggested that several complex factors have an important impact on hepatitis C virus-related mortality. However, the evaluation of such factors using a deceased case-living control study with a large number of patients has not been reported. The aim of the present study was to investigate the risk factors for liver-related mortality in chronic hepatitis C (CHC) patients using a deceased case-living control study design. This study indicates that interferon-α plus ribavirin treatment, the stage at the initial diagnosis and comorbidities are all independent risk factors for liver-related mortality in CHC patients.