Prediction of Mortality in Chronic Liver Disease Using Non-hepatic Comorbidities: No SI of Relief as Yet

Excerpt

A significant proportion of mortality in patients with chronic hepatitis C with or without cirrhosis is related to non-hepatic comorbidities such as cardiovascular or psychiatric disease, drug or alcohol use, renal failure, and non-hepatic cancers [1]. Curing underlying hepatitis C reduces but does not eliminate the higher rates of liver-related and all-cause mortality typical of patients with chronic HCV infection [2, 3]. Although ~70% of the observed mortality reported in large cohorts of patients with chronic hepatitis C-related cirrhosis can be predicted using liver-specific risk prediction models such as Child–Turcotte–Pugh (CTP) or Model for End-Stage Liver Disease (MELD) [4], the remaining variance largely relates to ‘unpredictable’ (e.g., accidents, homicide, suicide) and more ‘predictable’ non-hepatic morbidities (e.g., heart disease, chronic lung disease, renal failure, stroke). Optimized systems to predict the remaining variance could have important implications for public policy, and if calculable at the point-of-care, possibly impact shared clinician–patient medical decision-making. …