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

[Guest guest]

Alimentary Pharmacology & Therapeutics 27 (9) , 798–809

doi:10.1111/j.1365-2036.2008.03639.x

Abstract

The spectrum of hepatic functional impairment in compensated chronic hepatitis

C: results from the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial1

G. T. EVERSON**Section of Hepatology, Division of Gastroenterology and

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

SHIFFMAN††Division of Gastroenterology, Hepatology, and Nutrition, Hepatology

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

R. MORGAN‡,§‡Division of Gastroenterology, University of California – Irvine,

Irvine, CA, USA§Gastroenterology Service, VA Long Beach Healthcare System, Long

Beach, CA, USA, J. C. HOEFS‡,§‡Division of Gastroenterology, University of

California – Irvine, Irvine, CA, USA§Gastroenterology Service, VA Long Beach

Healthcare System, Long Beach, CA, USA, R. K. STERLING††Division of

Gastroenterology, Hepatology, and Nutrition, Hepatology Section, Virginia

Commonwealth University Health System, Richmond, VA, USA, D. A.

WAGNER¶¶Metabolic Solutions, Inc., Nashua, NH, USA, C. C. KULIG**Section of

Hepatology, Division of Gastroenterology and Hepatology, University of Colorado

School of Medicine, Denver, CO, USA, T. M. CURTO****New England Research

Institutes, Watertown, MA, USA E. C. WRIGHT††††Office of the Director,

Department of Health and Human Services, National Institute of Diabetes and

Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

& THE HALT-C TRIAL GROUP*Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, USA;

†Division of Gastroenterology, Hepatology, and Nutrition, Hepatology Section,

Virginia Commonwealth University Health System, Richmond, VA, USA; ‡Division of

Gastroenterology, University of California – Irvine, Irvine, CA, USA;

§Gastroenterology Service, VA Long Beach Healthcare System, Long Beach, CA, USA;

¶Metabolic Solutions, Inc., Nashua, NH, USA; **New England Research Institutes,

Watertown, MA, USA; ††Office of the Director, Department of Health and Human

Services, National Institute of Diabetes and Digestive and Kidney Diseases,

National Institutes of Health, Bethesda, MD, USA

Prof. G. T. Everson, University of Colorado Health Sciences Center, 4200 East

9th Avenue, B-154, Denver, CO 80262, USA.

E-mail: greg.everson@...

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

Summary

Background The spectrum of functional impairment in patients with compensated

chronic hepatitis C is incompletely defined.

Aim To define hepatic impairment by quantitative tests (quantitative liver

function tests) and correlate results with disease severity in patients with

chronic hepatitis C.

Methods We studied 285 adult patients with chronic hepatitis C prior to

treatment in the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial; 171 had Ishak fibrosis stages 2–4 (fibrosis) and 114 had stage 5 or 6

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

liver function test 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 45–89% with cirrhosis

had hepatic impairment by quantitative liver function test; patients with

cirrhosis had the greatest impairment (P-value ranging from 0.15 to < 95 and

cholate shunt>35% identified 91% of patients with medium- or large-sized

varices.

Conclusions Hepatic impairment is common in compensated patients with fibrosis

or cirrhosis because of chronic hepatitis C. Cholate shunt, and cholate Cloral

and perfused hepatic mass, 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 27 (9) , 798–809

doi:10.1111/j.1365-2036.2008.03639.x

Abstract

The spectrum of hepatic functional impairment in compensated chronic hepatitis

C: results from the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial1

G. T. EVERSON**Section of Hepatology, Division of Gastroenterology and

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

SHIFFMAN††Division of Gastroenterology, Hepatology, and Nutrition, Hepatology

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

R. MORGAN‡,§‡Division of Gastroenterology, University of California – Irvine,

Irvine, CA, USA§Gastroenterology Service, VA Long Beach Healthcare System, Long

Beach, CA, USA, J. C. HOEFS‡,§‡Division of Gastroenterology, University of

California – Irvine, Irvine, CA, USA§Gastroenterology Service, VA Long Beach

Healthcare System, Long Beach, CA, USA, R. K. STERLING††Division of

Gastroenterology, Hepatology, and Nutrition, Hepatology Section, Virginia

Commonwealth University Health System, Richmond, VA, USA, D. A.

WAGNER¶¶Metabolic Solutions, Inc., Nashua, NH, USA, C. C. KULIG**Section of

Hepatology, Division of Gastroenterology and Hepatology, University of Colorado

School of Medicine, Denver, CO, USA, T. M. CURTO****New England Research

Institutes, Watertown, MA, USA E. C. WRIGHT††††Office of the Director,

Department of Health and Human Services, National Institute of Diabetes and

Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

& THE HALT-C TRIAL GROUP*Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, USA;

†Division of Gastroenterology, Hepatology, and Nutrition, Hepatology Section,

Virginia Commonwealth University Health System, Richmond, VA, USA; ‡Division of

Gastroenterology, University of California – Irvine, Irvine, CA, USA;

§Gastroenterology Service, VA Long Beach Healthcare System, Long Beach, CA, USA;

¶Metabolic Solutions, Inc., Nashua, NH, USA; **New England Research Institutes,

Watertown, MA, USA; ††Office of the Director, Department of Health and Human

Services, National Institute of Diabetes and Digestive and Kidney Diseases,

National Institutes of Health, Bethesda, MD, USA

Prof. G. T. Everson, University of Colorado Health Sciences Center, 4200 East

9th Avenue, B-154, Denver, CO 80262, USA.

E-mail: greg.everson@...

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

Summary

Background The spectrum of functional impairment in patients with compensated

chronic hepatitis C is incompletely defined.

Aim To define hepatic impairment by quantitative tests (quantitative liver

function tests) and correlate results with disease severity in patients with

chronic hepatitis C.

Methods We studied 285 adult patients with chronic hepatitis C prior to

treatment in the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial; 171 had Ishak fibrosis stages 2–4 (fibrosis) and 114 had stage 5 or 6

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

liver function test 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 45–89% with cirrhosis

had hepatic impairment by quantitative liver function test; patients with

cirrhosis had the greatest impairment (P-value ranging from 0.15 to < 95 and

cholate shunt>35% identified 91% of patients with medium- or large-sized

varices.

Conclusions Hepatic impairment is common in compensated patients with fibrosis

or cirrhosis because of chronic hepatitis C. Cholate shunt, and cholate Cloral

and perfused hepatic mass, identify patients at risk for cirrhosis or varices.

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

_________________________________________________________________

Pack up or back up–use SkyDrive to transfer files or keep extra copies. Learn

how.

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ydrive_packup_042008

[Guest guest]

Alimentary Pharmacology & Therapeutics 27 (9) , 798–809

doi:10.1111/j.1365-2036.2008.03639.x

Abstract

The spectrum of hepatic functional impairment in compensated chronic hepatitis

C: results from the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial1

G. T. EVERSON**Section of Hepatology, Division of Gastroenterology and

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

SHIFFMAN††Division of Gastroenterology, Hepatology, and Nutrition, Hepatology

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

R. MORGAN‡,§‡Division of Gastroenterology, University of California – Irvine,

Irvine, CA, USA§Gastroenterology Service, VA Long Beach Healthcare System, Long

Beach, CA, USA, J. C. HOEFS‡,§‡Division of Gastroenterology, University of

California – Irvine, Irvine, CA, USA§Gastroenterology Service, VA Long Beach

Healthcare System, Long Beach, CA, USA, R. K. STERLING††Division of

Gastroenterology, Hepatology, and Nutrition, Hepatology Section, Virginia

Commonwealth University Health System, Richmond, VA, USA, D. A.

WAGNER¶¶Metabolic Solutions, Inc., Nashua, NH, USA, C. C. KULIG**Section of

Hepatology, Division of Gastroenterology and Hepatology, University of Colorado

School of Medicine, Denver, CO, USA, T. M. CURTO****New England Research

Institutes, Watertown, MA, USA E. C. WRIGHT††††Office of the Director,

Department of Health and Human Services, National Institute of Diabetes and

Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

& THE HALT-C TRIAL GROUP*Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, USA;

†Division of Gastroenterology, Hepatology, and Nutrition, Hepatology Section,

Virginia Commonwealth University Health System, Richmond, VA, USA; ‡Division of

Gastroenterology, University of California – Irvine, Irvine, CA, USA;

§Gastroenterology Service, VA Long Beach Healthcare System, Long Beach, CA, USA;

¶Metabolic Solutions, Inc., Nashua, NH, USA; **New England Research Institutes,

Watertown, MA, USA; ††Office of the Director, Department of Health and Human

Services, National Institute of Diabetes and Digestive and Kidney Diseases,

National Institutes of Health, Bethesda, MD, USA

Prof. G. T. Everson, University of Colorado Health Sciences Center, 4200 East

9th Avenue, B-154, Denver, CO 80262, USA.

E-mail: greg.everson@...

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

Summary

Background The spectrum of functional impairment in patients with compensated

chronic hepatitis C is incompletely defined.

Aim To define hepatic impairment by quantitative tests (quantitative liver

function tests) and correlate results with disease severity in patients with

chronic hepatitis C.

Methods We studied 285 adult patients with chronic hepatitis C prior to

treatment in the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial; 171 had Ishak fibrosis stages 2–4 (fibrosis) and 114 had stage 5 or 6

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

liver function test 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 45–89% with cirrhosis

had hepatic impairment by quantitative liver function test; patients with

cirrhosis had the greatest impairment (P-value ranging from 0.15 to < 95 and

cholate shunt>35% identified 91% of patients with medium- or large-sized

varices.

Conclusions Hepatic impairment is common in compensated patients with fibrosis

or cirrhosis because of chronic hepatitis C. Cholate shunt, and cholate Cloral

and perfused hepatic mass, 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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hthttp://www.windowslive.com/skydrive/overview.html?ocid=TXT_TAGLM_WL_Refresh_sk\

ydrive_packup_042008

[Guest guest]

Alimentary Pharmacology & Therapeutics 27 (9) , 798–809

doi:10.1111/j.1365-2036.2008.03639.x

Abstract

The spectrum of hepatic functional impairment in compensated chronic hepatitis

C: results from the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial1

G. T. EVERSON**Section of Hepatology, Division of Gastroenterology and

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

SHIFFMAN††Division of Gastroenterology, Hepatology, and Nutrition, Hepatology

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

R. MORGAN‡,§‡Division of Gastroenterology, University of California – Irvine,

Irvine, CA, USA§Gastroenterology Service, VA Long Beach Healthcare System, Long

Beach, CA, USA, J. C. HOEFS‡,§‡Division of Gastroenterology, University of

California – Irvine, Irvine, CA, USA§Gastroenterology Service, VA Long Beach

Healthcare System, Long Beach, CA, USA, R. K. STERLING††Division of

Gastroenterology, Hepatology, and Nutrition, Hepatology Section, Virginia

Commonwealth University Health System, Richmond, VA, USA, D. A.

WAGNER¶¶Metabolic Solutions, Inc., Nashua, NH, USA, C. C. KULIG**Section of

Hepatology, Division of Gastroenterology and Hepatology, University of Colorado

School of Medicine, Denver, CO, USA, T. M. CURTO****New England Research

Institutes, Watertown, MA, USA E. C. WRIGHT††††Office of the Director,

Department of Health and Human Services, National Institute of Diabetes and

Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

& THE HALT-C TRIAL GROUP*Section of Hepatology, Division of Gastroenterology and

Hepatology, University of Colorado School of Medicine, Denver, CO, USA;

†Division of Gastroenterology, Hepatology, and Nutrition, Hepatology Section,

Virginia Commonwealth University Health System, Richmond, VA, USA; ‡Division of

Gastroenterology, University of California – Irvine, Irvine, CA, USA;

§Gastroenterology Service, VA Long Beach Healthcare System, Long Beach, CA, USA;

¶Metabolic Solutions, Inc., Nashua, NH, USA; **New England Research Institutes,

Watertown, MA, USA; ††Office of the Director, Department of Health and Human

Services, National Institute of Diabetes and Digestive and Kidney Diseases,

National Institutes of Health, Bethesda, MD, USA

Prof. G. T. Everson, University of Colorado Health Sciences Center, 4200 East

9th Avenue, B-154, Denver, CO 80262, USA.

E-mail: greg.everson@...

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

Summary

Background The spectrum of functional impairment in patients with compensated

chronic hepatitis C is incompletely defined.

Aim To define hepatic impairment by quantitative tests (quantitative liver

function tests) and correlate results with disease severity in patients with

chronic hepatitis C.

Methods We studied 285 adult patients with chronic hepatitis C prior to

treatment in the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis

Trial; 171 had Ishak fibrosis stages 2–4 (fibrosis) and 114 had stage 5 or 6

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

liver function test 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 45–89% with cirrhosis

had hepatic impairment by quantitative liver function test; patients with

cirrhosis had the greatest impairment (P-value ranging from 0.15 to < 95 and

cholate shunt>35% identified 91% of patients with medium- or large-sized

varices.

Conclusions Hepatic impairment is common in compensated patients with fibrosis

or cirrhosis because of chronic hepatitis C. Cholate shunt, and cholate Cloral

and perfused hepatic mass, identify patients at risk for cirrhosis or varices.

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

_________________________________________________________________

Pack up or back up–use SkyDrive to transfer files or keep extra copies. Learn

how.

hthttp://www.windowslive.com/skydrive/overview.html?ocid=TXT_TAGLM_WL_Refresh_sk\

ydrive_packup_042008