Chronic HCV patients have higher all-cause mortality

Patients with chronic hepatitis C infection had a greater than twofold risk for dying from both liver and non-liver related causes compared to those who tested negative for the disease, data from a nationally representative study indicate.

“This should reinforce the importance of preventive measures, particularly among individuals at risk for acquiring the disease, as well as early diagnosis and improving access to care for those already infected, even in the absence of liver disease,” study researcher Samar S. El-Kamary, FAAP, MPH, an assistant professor at the University of Maryland School of Medicine, said in a press release.

El-Kamary and colleagues assessed HCV status among 9,378 adults aged 17 to 59 years who participated in the National Health and Nutrition Examination Survey (NHANES) III from 1988 to 1994 and performed mortality follow-up on the same individuals through 2006.

A total of 614 deaths occurred during the median 14.8-year follow-up. The researchers identified 203 people with chronic hepatitis C infection, 44 of whom died.  Among HCV positive individuals, the cause of death was liver-related in nine people, whereas 35 deaths were attributable to HIV, diabetes, heart disease, cancer and other causes.

After adjusting for all covariate risk factors, the all-cause mortality rate ratio was 2.37 times greater among individuals with chronic HCV infection compared with those without the disease (95% CI: 1.28-4.38; P=.008).

Nonliver-related mortality rate ratios were 1.79 times higher (95% CI: .77-4.19; P=0.18), whereas liver-related mortality rate ratios were 26.46 times higher (95% CI: 8.00-87.48; P<.001) compared with patients that were not positive for HCV.

“While a hepatitis C infection may not be the cause of death, patients with the disease may be at a higher risk of dying due to other high-risk behaviors that may have also caused the infection,” El-Kamary explained.

Lower socioeconomic status, barriers to health care access and genetic predisposition may also contribute to non-liver related deaths among these patients, according to the researchers.

“Given the low cost for hepatitis C tests, perhaps it would be advisable to consider more liberal early screening of patients if there is any suspicion of infection so that they can be referred for treatment as early as possible,” El-Kamary said.

Study limitations include the observational study design, the self-reported nature of the data and the potential that non-liver related deaths were overestimated due to undiagnosed liver disease.

El-Kamary SS et al. Clin Infect Dis. 2011; doi:10/1093/cid/cir306.

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