Thématique :
- Foie
Originalité :
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
Journal of Hepatology
  2018 May;68(5):940-948.  
  doi: 10.1016/j.jhep.2017.12.019.  
  Impact of comorbidities on patient outcomes after interferon-free therapy-induced viral eradication in hepatitis C  
  Ampuero J, Jimeno C, Quiles R, Rosales JM, Llerena S, Palomo N, Cordero P, Serrano FJ, Urquijo JJ, Moreno-Planas JM, Ontanilla G, Hernández M, Ortega-Alonso A, Maraver M, Bonacci M, Rojas Á, Figueruela B, Forns X, Andrade RJ, Calleja JL, Diago M, Carmona I, de la Mata M, Buti M, Crespo J, Pascasio JM, Navarro JM, Salmerón J, Romero-Gómez M  



Patients with advanced liver fibrosis remain at risk of cirrhosis-related outcomes and those with severe comorbidities may not benefit from hepatitis C (HCV) eradication. We aimed to collect data on all-cause mortality and relevant clinical events within the first two years of direct-acting antiviral therapy, whilst determining the prognostic capability of a comorbidity-based model.


This was a prospective non-interventional study, from the beginning of direct-acting antiviral therapy to the event of interest (mortality) or up to two years of follow-up, including 14 Spanish University Hospitals. Patients with HCV infection, irrespective of liver fibrosis stage, who received direct-acting antiviral therapy were used to build an estimation and a validation cohort. Comorbidity was assessed according to Charlson comorbidity and CirCom indexes.


A total of 3.4% (65/1,891) of individuals died within the first year, while 5.4% (102/1,891) died during the study. After adjusting for cirrhosis, platelet count, alanine aminotransferase and sex, the following factors were independently associated with one-year mortality: Charlson index (hazard ratio [HR] 1.55; 95% CI 1.29-1.86; p = 0.0001), bilirubin (HR 1.39; 95% CI 1.11-1.75; p = 0.004), age (HR 1.06 95% CI 1.02-1.11; p = 0.005), international normalized ratio (HR 3.49; 95% CI 1.36-8.97; p = 0.010), and albumin (HR 0.18; 95% CI 0.09-0.37; p = 0.0001). HepCom score showed a good calibration and discrimination (C-statistics 0.90), and was superior to the other prognostic scores (model for end-stage liver disease 0.81, Child-Pugh 0.72, CirCom 0.68) regarding one- and two-year mortality. HepCom score identified low- (≤5.7 points: 2%-3%) and high-risk (≥25 points: 56%-59%) mortality groups, both in the estimation and validation cohorts. The distribution of clinical events was similar between groups.


The HepCom score, a combination of Charlson comorbidity index, age, and liver function (international normalized ratio, albumin, and bilirubin) enables detection of a group at high risk of one- and two-year mortality, and relevant clinical events, after starting direct-acting antiviral therapy.


The prognosis of patients with severe comorbidities may not benefit from HCV viral clearance. An algorithm to decide who will benefit from the treatment is needed to manage the chronic HCV infection better.


Question posée
Impact des comorbidités sur les devenir des patients après éradication virale induite par un traitement sans interféron dans l'hépatite C.
Question posée
Le score HepCom, une combinaison de l'indice de comorbidité Charlson, de l'âge et de la fonction hépatique (voir références dans les commentaires) permet de détecter un groupe à haut risque de mortalité après un et deux ans ayant été traité par thérapie antivirale à action directe.

A voir en 1987 :

Indice de comorbidité de Charlson. (Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies : development and validation. J Chronic Dis 1987 ; 40 : 373-83.]).