The risk of end stage liver disease and HCC

liver411

THE AMERICAN JOURNAL OF GASTROENTEROLOGY
Volume 98 , Issue 11 , Pages 2535-2542

The risk of end stage liver disease and hepatocellular carcinoma among
persons infected with hepatitis C virus: publication bias?

Boone Goodgame b , Nicholas J. Shaheen c , Joseph Galanko c and Hashem B.
El-Serag a,b,c *
Received: 1/31/2003. Accepted: 5/20/2003.
--------------------------------------------------------------------------------
Abstract

Objectives
In persons infected with hepatitis C virus (HCV), the incidence of cirrhosis
and hepatocellular carcinoma (HCC) can be estimated by examining over time
entire cohorts with known onset of HCV infection. We performed a systematic
review of the literature to identify and to analyze studies that examine
such cohorts.

Methods
A search of all articles from 1980 to 2001 was performed. Published studies
were included in which chronic HCV infection was defined by elevation of
liver enzymes or persistent RNA. We excluded studies in which cohorts were
selected from patients with prevalent liver disease or in whom the onset of
infection could not be estimated. Two investigators abstracted the data. The
incidences of cirrhosis and HCC were analyzed in all studies and in
categories based on study design, mode of HCV acquisition, sample size and
duration of follow-up, age at the onset of infection, and the quality of
estimating the onset of HCV infection.

Results
Of the articles, 21 fulfilled the selection criteria. Studies varied in
sample size (17-1,680), duration of follow-up (8-45 yr), total person-years
(157-34,098), and the mean age at onset of HCV (5-58 yr). The mean time to
end stage liver disease (ESLD) was 4-23 yr and to HCC was 9-31 yr. A funnel
plot showed a possible publication bias against studies with low incidence
of ESLD and HCC. The pooled weighted incidence rates for ESLD and HCC based
on infection mode were as follows: community-acquired HCV, 1.9 and 0 per
1,000 person-years; transfusion associated, 4.5 and 0.7; hemophilia
patients, 7.9 and 1.0; anti-D IgG, 0.7 and 0 per 1,000 person-years. Poisson
regression modeling showed that the incidence of ESLD is increased in
studies with a low quality estimate of the onset of HCV infection, in
community-acquired and transfusion-associated HCV, and in studies with
prospective design.

Conclusions
We found large variation in the incidence estimates of cirrhosis and HCC.
Short duration of follow-up, small sample size, and possible publication
bias may explain some of this variation. Low quality estimates of the onset
of HCV infection, a prospective study design, and a transfusion- or
hemophilia-related mode of acquisition were independent predictors of high
reported incidence of ESLD.

--------------------------------------------------------------------------------
Affiliations:
a Sections of Gastroenterology and Health Services Research at the Houston
Veterans Affairs Medical Center, Houston, Texas, USA. b Sections of
Gastroenterology and Health Services Research at Baylor College of Medicine,
Houston, Texas, USA. c Division of Digestive Diseases and the Center for
Gastrointestinal Biology and Disease at the University of North Carolina,
Chapel Hill, North Carolina, USA.