Liver Fibrosis Tied to Hep C-Related Vasculitis Prognosis

Last Updated: June 24, 2011

FRIDAY, June 24 (HealthDay News) -- In patients with hepatitis C virus (HCV)-related systemic vasculitis, severity of liver fibrosis and vasculitis at baseline are associated with disease prognosis, according to a study published in the June issue of Arthritis & Rheumatism.

Benjamin Terrier, M.D., from the Assistance Publique Hôpitaux de Paris, and colleagues investigated the clinical, biologic, and therapeutic factors associated with prognosis in 151 HCV RNA-positive patients with vasculitis. Participants were followed up for 54 months between 1993 and 2009, during which time vasculitis was scored using the Five-Factors Score (FFS). Data were collected on clinical, biologic, and therapeutic factors at the initial evaluation, during and at the end of follow-up.

The investigators found that 32 patients died mainly of infection and end-stage liver disease during the follow-up period. Survival rates were 96 percent at one year, 86 percent at three years, 75 percent at five years, and 63 percent at 10 years. Poor prognosis was associated with severe liver fibrosis (hazard ratio [HR], 5.31), and central nervous system, kidney, and heart involvement (HR, 2.74, 1.91, and 4.2, respectively) at baseline. FFS and severe fibrosis correlated significantly with poor prognosis in a multivariate analysis (HR, 2.49 and 10.8, respectively). After adjusting for vasculitis severity, treatment with PEGylated interferon plus ribavirin correlated with a good prognosis (HR 0.34), and treatment with immunosuppressive agents was linked to a poor outcome (HR, 4.05). FFS was a good predictor of outcome, but severity of vasculitis had no prognostic effect on patients without severe fibrosis.

"At the time of the diagnosis of HCV-related systemic vasculitis, severe liver fibrosis and the severity of vasculitis were the main prognostic factors," the authors write.

One of the study authors disclosed financial ties to the pharmaceutical industry.

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