Elevated liver enzymes predict morbidity and mortality despite antiviral cure in patients with chronic hepatitis C: Data from the German Hepatitis C‐Registry.
| Title: | Elevated liver enzymes predict morbidity and mortality despite antiviral cure in patients with chronic hepatitis C: Data from the German Hepatitis C‐Registry. |
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| Authors: | Tacke, Frank, Klinker, Hartwig, Boeker, Klaus H. W., Merle, Uta, Link, Ralph, Buggisch, Peter, Hüppe, Dietrich, Cornberg, Markus, Sarrazin, Christoph, Wedemeyer, Heiner, Berg, Thomas, Mauss, Stefan, Simon, Karl‐Georg, John, Christine, Stoehr, Albrecht, Teuber, Gerlinde, Ullrich, Rainer, Naumann, Uwe, Günther, Rainer, Christensen, Stefan |
| Source: | Hepatology Communications; Sep2022, Vol. 6 Issue 9, p2488-2495, 8p |
| Subject Terms: | HEPATITIS C, GAMMA-glutamyltransferase, CHRONIC hepatitis C, ALANINE aminotransferase, LIVER enzymes, NON-alcoholic fatty liver disease, HEPATITIS, HEPATITIS C virus |
| Abstract: | While direct‐acting antivirals (DAAs) cure chronic hepatitis C virus (HCV) infection in almost all patients, some patients remain at risk of liver disease despite HCV cure. In order to identify risk factors indicating liver‐related morbidity and death after viral cure, we included 6982 patients from the national multicenter real‐world German Hepatitis C Registry with regular follow‐up visits for up to 7 years after DAA therapy. Definitions for normal liver function tests (in women/men) were alanine aminotransferase (ALT; ≤35/≤50 U/L), ALT according to American Association for the Study of Liver Diseases (AASLD; ≤19/≤30 U/L), and gamma‐glutamyltransferase (GGT; ≤40/≤60 U/L). In our cohort, 97.4% of patients achieved sustained virologic response (SVR). At 24 weeks after SVR (SVR24), elevated ALT occurred in 657/6982 (9.4%), elevated ALT (AASLD) in 2609/6982 (37.4%), and elevated GGT in 1777/6982 (25.5%) patients. Risk factors for increased ALT at SVR24 were obesity, alcohol, cirrhosis, elevated baseline ALT, and non‐SVR. Increased GGT at SVR24 was significantly (p < 0.05) and independently associated with male sex (odds ratio [OR], 2.12), higher body mass index (OR, 1.04), age >50 years (OR, 1.60), liver cirrhosis (OR, 3.97), alcohol consumption (OR, 2.99), diabetes (OR, 1.63), non‐SVR (OR, 8.00), and elevated GGT at baseline (OR, 17.12). In multivariate regression analysis, elevated GGT at SVR24, particularly in combination with cirrhosis, was the best predictor for hepatic decompensation, hepatocellular carcinoma development, and death, followed by elevated ALT (AASLD) and standard ALT, which predicted hepatic decompensation. Despite successful HCV therapy, elevated GGT at SVR24 and to a lesser extent ALT are predictive of the future clinical outcome and linked with liver‐associated comorbidities. This may highlight the relevance of nonalcoholic fatty liver disease, diabetes mellitus, alcohol, and cirrhosis for the clinical outcome in a vulnerable population, even after HCV cure. [ABSTRACT FROM AUTHOR] |
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| Database: | Complementary Index |
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| Items | – Name: Title Label: Title Group: Ti Data: Elevated liver enzymes predict morbidity and mortality despite antiviral cure in patients with chronic hepatitis C: Data from the German Hepatitis C‐Registry. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Tacke%2C+Frank%22">Tacke, Frank</searchLink><br /><searchLink fieldCode="AR" term="%22Klinker%2C+Hartwig%22">Klinker, Hartwig</searchLink><br /><searchLink fieldCode="AR" term="%22Boeker%2C+Klaus+H%2E+W%2E%22">Boeker, Klaus H. W.</searchLink><br /><searchLink fieldCode="AR" term="%22Merle%2C+Uta%22">Merle, Uta</searchLink><br /><searchLink fieldCode="AR" term="%22Link%2C+Ralph%22">Link, Ralph</searchLink><br /><searchLink fieldCode="AR" term="%22Buggisch%2C+Peter%22">Buggisch, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Hüppe%2C+Dietrich%22">Hüppe, Dietrich</searchLink><br /><searchLink fieldCode="AR" term="%22Cornberg%2C+Markus%22">Cornberg, Markus</searchLink><br /><searchLink fieldCode="AR" term="%22Sarrazin%2C+Christoph%22">Sarrazin, Christoph</searchLink><br /><searchLink fieldCode="AR" term="%22Wedemeyer%2C+Heiner%22">Wedemeyer, Heiner</searchLink><br /><searchLink fieldCode="AR" term="%22Berg%2C+Thomas%22">Berg, Thomas</searchLink><br /><searchLink fieldCode="AR" term="%22Mauss%2C+Stefan%22">Mauss, Stefan</searchLink><br /><searchLink fieldCode="AR" term="%22Simon%2C+Karl‐Georg%22">Simon, Karl‐Georg</searchLink><br /><searchLink fieldCode="AR" term="%22John%2C+Christine%22">John, Christine</searchLink><br /><searchLink fieldCode="AR" term="%22Stoehr%2C+Albrecht%22">Stoehr, Albrecht</searchLink><br /><searchLink fieldCode="AR" term="%22Teuber%2C+Gerlinde%22">Teuber, Gerlinde</searchLink><br /><searchLink fieldCode="AR" term="%22Ullrich%2C+Rainer%22">Ullrich, Rainer</searchLink><br /><searchLink fieldCode="AR" term="%22Naumann%2C+Uwe%22">Naumann, Uwe</searchLink><br /><searchLink fieldCode="AR" term="%22Günther%2C+Rainer%22">Günther, Rainer</searchLink><br /><searchLink fieldCode="AR" term="%22Christensen%2C+Stefan%22">Christensen, Stefan</searchLink> – Name: TitleSource Label: Source Group: Src Data: Hepatology Communications; Sep2022, Vol. 6 Issue 9, p2488-2495, 8p – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22HEPATITIS+C%22">HEPATITIS C</searchLink><br /><searchLink fieldCode="DE" term="%22GAMMA-glutamyltransferase%22">GAMMA-glutamyltransferase</searchLink><br /><searchLink fieldCode="DE" term="%22CHRONIC+hepatitis+C%22">CHRONIC hepatitis C</searchLink><br /><searchLink fieldCode="DE" term="%22ALANINE+aminotransferase%22">ALANINE aminotransferase</searchLink><br /><searchLink fieldCode="DE" term="%22LIVER+enzymes%22">LIVER enzymes</searchLink><br /><searchLink fieldCode="DE" term="%22NON-alcoholic+fatty+liver+disease%22">NON-alcoholic fatty liver disease</searchLink><br /><searchLink fieldCode="DE" term="%22HEPATITIS%22">HEPATITIS</searchLink><br /><searchLink fieldCode="DE" term="%22HEPATITIS+C+virus%22">HEPATITIS C virus</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: While direct‐acting antivirals (DAAs) cure chronic hepatitis C virus (HCV) infection in almost all patients, some patients remain at risk of liver disease despite HCV cure. In order to identify risk factors indicating liver‐related morbidity and death after viral cure, we included 6982 patients from the national multicenter real‐world German Hepatitis C Registry with regular follow‐up visits for up to 7 years after DAA therapy. Definitions for normal liver function tests (in women/men) were alanine aminotransferase (ALT; ≤35/≤50 U/L), ALT according to American Association for the Study of Liver Diseases (AASLD; ≤19/≤30 U/L), and gamma‐glutamyltransferase (GGT; ≤40/≤60 U/L). In our cohort, 97.4% of patients achieved sustained virologic response (SVR). At 24 weeks after SVR (SVR24), elevated ALT occurred in 657/6982 (9.4%), elevated ALT (AASLD) in 2609/6982 (37.4%), and elevated GGT in 1777/6982 (25.5%) patients. Risk factors for increased ALT at SVR24 were obesity, alcohol, cirrhosis, elevated baseline ALT, and non‐SVR. Increased GGT at SVR24 was significantly (p < 0.05) and independently associated with male sex (odds ratio [OR], 2.12), higher body mass index (OR, 1.04), age >50 years (OR, 1.60), liver cirrhosis (OR, 3.97), alcohol consumption (OR, 2.99), diabetes (OR, 1.63), non‐SVR (OR, 8.00), and elevated GGT at baseline (OR, 17.12). In multivariate regression analysis, elevated GGT at SVR24, particularly in combination with cirrhosis, was the best predictor for hepatic decompensation, hepatocellular carcinoma development, and death, followed by elevated ALT (AASLD) and standard ALT, which predicted hepatic decompensation. Despite successful HCV therapy, elevated GGT at SVR24 and to a lesser extent ALT are predictive of the future clinical outcome and linked with liver‐associated comorbidities. This may highlight the relevance of nonalcoholic fatty liver disease, diabetes mellitus, alcohol, and cirrhosis for the clinical outcome in a vulnerable population, even after HCV cure. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of Hepatology Communications is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/hep4.2015 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 8 StartPage: 2488 Subjects: – SubjectFull: HEPATITIS C Type: general – SubjectFull: GAMMA-glutamyltransferase Type: general – SubjectFull: CHRONIC hepatitis C Type: general – SubjectFull: ALANINE aminotransferase Type: general – SubjectFull: LIVER enzymes Type: general – SubjectFull: NON-alcoholic fatty liver disease Type: general – SubjectFull: HEPATITIS Type: general – SubjectFull: HEPATITIS C virus Type: general Titles: – TitleFull: Elevated liver enzymes predict morbidity and mortality despite antiviral cure in patients with chronic hepatitis C: Data from the German Hepatitis C‐Registry. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Tacke, Frank – PersonEntity: Name: NameFull: Klinker, Hartwig – PersonEntity: Name: NameFull: Boeker, Klaus H. W. – PersonEntity: Name: NameFull: Merle, Uta – PersonEntity: Name: NameFull: Link, Ralph – PersonEntity: Name: NameFull: Buggisch, Peter – PersonEntity: Name: NameFull: Hüppe, Dietrich – PersonEntity: Name: NameFull: Cornberg, Markus – PersonEntity: Name: NameFull: Sarrazin, Christoph – PersonEntity: Name: NameFull: Wedemeyer, Heiner – PersonEntity: Name: NameFull: Berg, Thomas – PersonEntity: Name: NameFull: Mauss, Stefan – PersonEntity: Name: NameFull: Simon, Karl‐Georg – PersonEntity: Name: NameFull: John, Christine – PersonEntity: Name: NameFull: Stoehr, Albrecht – PersonEntity: Name: NameFull: Teuber, Gerlinde – PersonEntity: Name: NameFull: Ullrich, Rainer – PersonEntity: Name: NameFull: Naumann, Uwe – PersonEntity: Name: NameFull: Günther, Rainer – PersonEntity: Name: NameFull: Christensen, Stefan IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 09 Text: Sep2022 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 2471254X Numbering: – Type: volume Value: 6 – Type: issue Value: 9 Titles: – TitleFull: Hepatology Communications Type: main |
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