The spectrum of hepatic functional impairment in compensated chronic hepatitis C: results from the H

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Alimentary Pharmacology & Therapeutics (OnlineAccepted Articles).

doi:10.1111/j.1365-2036.2008.03639.x

Abstract

Original Article

The spectrum of hepatic functional impairment in compensated chronic hepatitis

C: results from the HALT-C trial

G. T. EVERSON11. Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, M. L.

SHIFFMAN22. Division of Gastroenterology, Hepatology, and Nutrition, Hepatology

Section, Virginia Commonwealth University Health System, Richmond, VA, T. R.

MORGAN33. Division of Gastroenterology, University of California - Irvine,

Irvine, CA and Gastroenterology Service, VA Long Beach Healthcare System, Long

Beach, CA, J. C. HOEFS33. Division of Gastroenterology, University of California

- Irvine, Irvine, CA and Gastroenterology Service, VA Long Beach Healthcare

System, Long Beach, CA, R. K. STERLING22. Division of Gastroenterology,

Hepatology, and Nutrition, Hepatology Section, Virginia Commonwealth University

Health System, Richmond, VA, D. A. WAGNER44. Metabolic Solutions, Inc., Nashua,

NH, C. C. KULIG11. Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, T. M.

CURTO55. New England Research Institutes, Watertown, MA, E. C. WRIGHT66. Office

of the Director, National Institute of Diabetes and Digestive and Kidney

Diseases, National Institutes of Health, Department of Health and Human

Services, Bethesda, MD & the HALT-C Trial Group.1. Section of Hepatology,

Division of Gastroenterology and Hepatology, University of Colorado School of

Medicine, Denver, CO

2. Division of Gastroenterology, Hepatology, and Nutrition, Hepatology Section,

Virginia Commonwealth University Health System, Richmond, VA

3. Division of Gastroenterology, University of California - Irvine, Irvine, CA

and Gastroenterology Service, VA Long Beach Healthcare System, Long Beach, CA

4. Metabolic Solutions, Inc., Nashua, NH

5. New England Research Institutes, Watertown, MA

6. Office of the Director, National Institute of Diabetes and Digestive and

Kidney Diseases, National Institutes of Health, Department of Health and Human

Services, Bethesda, MD

Address Correspondence to:

T. Everson, M.D.

Professor of Medicine

Director of Hepatology

University of Colorado Health Sciences Center

4200 East 9th Avenue, B-154

Denver, CO 80262

Phone: 303-372-8859

FAX: 303-372-8868

EMAIL: greg.everson@...

Page 1 footnote: This is publication number 18 from the HALT-C Trial Group.

QLFTs, quantitative liver function testsHALT-C, Hepatitis C Antiviral Long-term

Treatment against CirrhosisPHM, perfused hepatic massCHC, chronic hepatitis

CINR, prothrombin time international normalized ratioMEGX, monoethylglycine

xylidideSPECT-LSS, single photon emission computed tomographic liver spleen

scanFDA, US Food and Drug AdministrationBMI, body mass indexHCV, hepatitis C

virusSD, standard deviationIND, Investigational New Drugkelim, elimination rate

constantCloral, clearance of oral administered compoundCliv, clearance of

intravenously administered compoundGEC, galactose elimination capacityMBT,

methionine breath testPPV, positive predictive valueNPV, negative predictive

valueROC, receiver operating characteristic

Abstract

BACKGROUND: The spectrum of functional impairment in patients with compensated

chronic hepatitis C (CHC) is incompletely defined.

AIM: To define hepatic impairment by quantitative tests (QLFTs) and correlate

results with disease severity in patients with CHC.

METHODS: We studied 285 adult patients with CHC prior to treatment in the

Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial; 171

had Ishak fibrosis stage 2 to 4 (fibrosis), and 114 had stage 5 or 6

(cirrhosis). None had had clinical decompensation. A battery of 12 QLFTs

assessed the spectrum of hepatic microsomal, mitochondrial, and cytosolic

functions, and hepatic and portal blood flow.

RESULTS: Twenty six to 63% of patients with fibrosis and 45 to 89% with

cirrhosis had hepatic impairment by QLFTs; patients with cirrhosis had greatest

impairment (p range from 0.15 to 35% identified 91% of patients with medium- or

large-sized varices.

CONCLUSIONS: Hepatic impairment is common in compensated patients with fibrosis

or cirrhosis due to chronic hepatitis C. Cholate shunt, and cholate Cloral, and

PHM identify patients at risk for cirrhosis or varices.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2008.03639.x

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[Guest guest]

Alimentary Pharmacology & Therapeutics (OnlineAccepted Articles).

doi:10.1111/j.1365-2036.2008.03639.x

Abstract

Original Article

The spectrum of hepatic functional impairment in compensated chronic hepatitis

C: results from the HALT-C trial

G. T. EVERSON11. Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, M. L.

SHIFFMAN22. Division of Gastroenterology, Hepatology, and Nutrition, Hepatology

Section, Virginia Commonwealth University Health System, Richmond, VA, T. R.

MORGAN33. Division of Gastroenterology, University of California - Irvine,

Irvine, CA and Gastroenterology Service, VA Long Beach Healthcare System, Long

Beach, CA, J. C. HOEFS33. Division of Gastroenterology, University of California

- Irvine, Irvine, CA and Gastroenterology Service, VA Long Beach Healthcare

System, Long Beach, CA, R. K. STERLING22. Division of Gastroenterology,

Hepatology, and Nutrition, Hepatology Section, Virginia Commonwealth University

Health System, Richmond, VA, D. A. WAGNER44. Metabolic Solutions, Inc., Nashua,

NH, C. C. KULIG11. Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, T. M.

CURTO55. New England Research Institutes, Watertown, MA, E. C. WRIGHT66. Office

of the Director, National Institute of Diabetes and Digestive and Kidney

Diseases, National Institutes of Health, Department of Health and Human

Services, Bethesda, MD & the HALT-C Trial Group.1. Section of Hepatology,

Division of Gastroenterology and Hepatology, University of Colorado School of

Medicine, Denver, CO

2. Division of Gastroenterology, Hepatology, and Nutrition, Hepatology Section,

Virginia Commonwealth University Health System, Richmond, VA

3. Division of Gastroenterology, University of California - Irvine, Irvine, CA

and Gastroenterology Service, VA Long Beach Healthcare System, Long Beach, CA

4. Metabolic Solutions, Inc., Nashua, NH

5. New England Research Institutes, Watertown, MA

6. Office of the Director, National Institute of Diabetes and Digestive and

Kidney Diseases, National Institutes of Health, Department of Health and Human

Services, Bethesda, MD

Address Correspondence to:

T. Everson, M.D.

Professor of Medicine

Director of Hepatology

University of Colorado Health Sciences Center

4200 East 9th Avenue, B-154

Denver, CO 80262

Phone: 303-372-8859

FAX: 303-372-8868

EMAIL: greg.everson@...

Page 1 footnote: This is publication number 18 from the HALT-C Trial Group.

QLFTs, quantitative liver function testsHALT-C, Hepatitis C Antiviral Long-term

Treatment against CirrhosisPHM, perfused hepatic massCHC, chronic hepatitis

CINR, prothrombin time international normalized ratioMEGX, monoethylglycine

xylidideSPECT-LSS, single photon emission computed tomographic liver spleen

scanFDA, US Food and Drug AdministrationBMI, body mass indexHCV, hepatitis C

virusSD, standard deviationIND, Investigational New Drugkelim, elimination rate

constantCloral, clearance of oral administered compoundCliv, clearance of

intravenously administered compoundGEC, galactose elimination capacityMBT,

methionine breath testPPV, positive predictive valueNPV, negative predictive

valueROC, receiver operating characteristic

Abstract

BACKGROUND: The spectrum of functional impairment in patients with compensated

chronic hepatitis C (CHC) is incompletely defined.

AIM: To define hepatic impairment by quantitative tests (QLFTs) and correlate

results with disease severity in patients with CHC.

METHODS: We studied 285 adult patients with CHC prior to treatment in the

Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial; 171

had Ishak fibrosis stage 2 to 4 (fibrosis), and 114 had stage 5 or 6

(cirrhosis). None had had clinical decompensation. A battery of 12 QLFTs

assessed the spectrum of hepatic microsomal, mitochondrial, and cytosolic

functions, and hepatic and portal blood flow.

RESULTS: Twenty six to 63% of patients with fibrosis and 45 to 89% with

cirrhosis had hepatic impairment by QLFTs; patients with cirrhosis had greatest

impairment (p range from 0.15 to 35% identified 91% of patients with medium- or

large-sized varices.

CONCLUSIONS: Hepatic impairment is common in compensated patients with fibrosis

or cirrhosis due to chronic hepatitis C. Cholate shunt, and cholate Cloral, and

PHM identify patients at risk for cirrhosis or varices.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2008.03639.x

_________________________________________________________________

Connect and share in new ways with Windows Live.

http://www.windowslive.com/share.html?ocid=TXT_TAGHM_Wave2_sharelife_012008