In the Journals

HepCom score detects high mortality risk during HCV treatment

The HepCom score — which combines Charlson Comorbidity Index, age, international normalized ratio, albumin and bilirubin — accurately detected patients with hepatitis C at high risk for 1- and 2-year mortality after the start of direct-acting antiviral therapy, according to recently published data.

“The HepCom score appears to identify better patients in which the overall prognosis is too short, even despite achieving SVR, more than to detect a not sufficiently high absolute benefit of the DAA therapy,” Javier Ampuero, MD, PhD, from the Virgen del Rocio University Hospitals, Spain, and colleagues wrote. “Therefore, it could help in conveying the health care efforts (either economic or monitoring) to hepatitis C patients more likely to benefit from these treatments.”

Ampuero and colleagues enrolled 1,891 adult patients with HCV and any stage of liver fibrosis into the study and followed them for up to 24 months.

Age (P < .0001), platelet count (P < .0001), international normalized ratio (P < .001), bilirubin (P = .003), albumin (P < .0001), alanine aminotransferase (P < .0001) and the presence of cirrhosis (P < .0001) correlated significantly with 1-year mortality in the estimation cohort.

After adjusting for cirrhosis, platelet count, ALT and sex, the researchers found that Charlson Index (HR = 1.55; 95% CI, 1.29-1.86), bilirubin (HR = 1.39; 95% CI, 1.11-1.75), age (HR = 1.06; 95% CI, 1.02-1.11) and INR (HR = 3.49; 95% CI, 1.36-8.97) correlated independently with increased 1-year mortality. In contrast, albumin correlated negatively with 1-year mortality (HR = 0.18; 95% CI, 0.09-0.37).

Compared with MELD score, Child-Pugh score and CirCom index, the HepCom score had greater results as a prognostic score in both 1- and 2-year mortality (P < .0001).

Among the 1,050 patients included in an estimation cohort, the cutoff of HepCom score 5.7 or lower correctly identified 90.8% of patients who survived to 2 years of follow-up with 1.8% incorrectly diagnosed. In contrast, a cutoff of HepCom score 25 or higher correctly identified 29% of patients with a 2-year mortality and 40.7% were incorrectly classified. With the cutoff range of 5.7 to 25, the model was able to detect the presence or absence of 2-year mortality in 87.8% of patients in the estimation cohort with a correct prediction of 97.1%.

“This pragmatic algorithm allowed recognizing three risk groups (including an intermediate-risk group) that evidenced different monthly and cumulative incidence rates of mortality and relevant clinical events from the first month to the final of follow-up,” the researchers concluded. “The HepCom score should be the first step in the management of HCV patients requiring antiviral therapy, because it can help to balance the risks and benefits of the treatment.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

The HepCom score — which combines Charlson Comorbidity Index, age, international normalized ratio, albumin and bilirubin — accurately detected patients with hepatitis C at high risk for 1- and 2-year mortality after the start of direct-acting antiviral therapy, according to recently published data.

“The HepCom score appears to identify better patients in which the overall prognosis is too short, even despite achieving SVR, more than to detect a not sufficiently high absolute benefit of the DAA therapy,” Javier Ampuero, MD, PhD, from the Virgen del Rocio University Hospitals, Spain, and colleagues wrote. “Therefore, it could help in conveying the health care efforts (either economic or monitoring) to hepatitis C patients more likely to benefit from these treatments.”

Ampuero and colleagues enrolled 1,891 adult patients with HCV and any stage of liver fibrosis into the study and followed them for up to 24 months.

Age (P < .0001), platelet count (P < .0001), international normalized ratio (P < .001), bilirubin (P = .003), albumin (P < .0001), alanine aminotransferase (P < .0001) and the presence of cirrhosis (P < .0001) correlated significantly with 1-year mortality in the estimation cohort.

After adjusting for cirrhosis, platelet count, ALT and sex, the researchers found that Charlson Index (HR = 1.55; 95% CI, 1.29-1.86), bilirubin (HR = 1.39; 95% CI, 1.11-1.75), age (HR = 1.06; 95% CI, 1.02-1.11) and INR (HR = 3.49; 95% CI, 1.36-8.97) correlated independently with increased 1-year mortality. In contrast, albumin correlated negatively with 1-year mortality (HR = 0.18; 95% CI, 0.09-0.37).

Compared with MELD score, Child-Pugh score and CirCom index, the HepCom score had greater results as a prognostic score in both 1- and 2-year mortality (P < .0001).

Among the 1,050 patients included in an estimation cohort, the cutoff of HepCom score 5.7 or lower correctly identified 90.8% of patients who survived to 2 years of follow-up with 1.8% incorrectly diagnosed. In contrast, a cutoff of HepCom score 25 or higher correctly identified 29% of patients with a 2-year mortality and 40.7% were incorrectly classified. With the cutoff range of 5.7 to 25, the model was able to detect the presence or absence of 2-year mortality in 87.8% of patients in the estimation cohort with a correct prediction of 97.1%.

“This pragmatic algorithm allowed recognizing three risk groups (including an intermediate-risk group) that evidenced different monthly and cumulative incidence rates of mortality and relevant clinical events from the first month to the final of follow-up,” the researchers concluded. “The HepCom score should be the first step in the management of HCV patients requiring antiviral therapy, because it can help to balance the risks and benefits of the treatment.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.