OBESITY AND HYPERTENSION (HTN) ARE ASSOCIATED WITH MORTALITY IN HEPATITIS C

Session Title: EASL GENERAL SESSION 4 & CLOSING

Presentation Date: Apr 26, 2009

TYPE 2 DIABETES (DM), OBESITY AND HYPERTENSION (HTN) ARE ASSOCIATED WITH MORTALITY IN HEPATITIS C (HCV) PATIENTS

N. Rafiq1,2, M. Stepanova1,2, B. Lam1, Z. Younossi1,2

1Center for Liver Diseases, Inova Fairfax Hospital, Inova Health System, 2Center for Integrated Research, Inova Health System, Falls Church, VA, USA

Background: Recent data suggests that components of metabolic syndrome (MS) are associated with adverse outcomes in HCV patients.

Aim: To determine the impact of components of MS on mortality of HCV patients.

Methods: We utilized the Third National Health and Nutrition Examination Survey (NHANES III) and Linked Mortality Files. HCV was defined as positive HCV RNA by PCR assay. Subjects without other causes of chronic liver disease such as presumed NAFLD, elevated serum aminotransferases (ALT> 40 U/L, AST> 37 U/L in men, and ALT> 31 U/L, AST>31 U/L in women), excessive alcohol use (>10 grams/day in women and > 20 grams/day in men), elevated transferrin saturation (>50%) and positive hepatitis Bs antigen were designated controls without liver disease. HCV patients were compared to HCV-negative individuals and controls without liver disease using Rao-Scott chi-square statistics. Adjusted hazard ratios (AHR, 95% CI) for overall mortality and cause-specific mortality were calculated for HCV patients using persons without HCV. Cox proportional hazard model was used for calculation of AHR for independent risk factors, and for the presence of HCV as a potential risk factor for overall mortality and cause-specific mortalities. MS was defined according to ATP-III and insulin resistance (IR) was defined as HOMA>3.0.

Results:

Cohort included 15,866 individuals with complete data. Among those, 264 patients were HCV-positive, and 13,004 were considered controls.

HCV patients had more IR (37.4±3.2% vs. 22.8±0.9%, p< 0.0001) and higher rate of DM (9.2±2.3% vs. 5.5±0.3%, p=0.0885) than controls.

In comparison to the HCV-negative patients, HCV patients had higher overall mortality (AHR=2.80, 2.79-2.81), higher liver-related mortality (AHR=17.96, 17.80-18.12), higher DM-related mortality (AHR=18.55, 18.36-18.74) and higher mortality from solid organ malignancy (AHR=1.601, 1.587-1.616).

In HCV-infected patients, top 3 predictors of liver related mortality were having higher BMI, presence of IR and elevated serum cholesterol.

In HCV patients, increased overall mortality was associated with components of MS [DM (AHR=2.139, 2.11-2.16), higher BMI (AHR=1.054, 1.53-1.055) and HTN (AHR=1.408, 1.394-1.422)].

In HCV patients, increased liver-related mortality was associated with higher BMI (AHR=1.275, 1.274-1.277) and HTN (AHR=3.751, 3.653-3.851).

Conclusions: Components of MS are associated with overall and liver-related mortality in HCV infected patients.