Disease progression statistics

[mike716]

Does anyone know where I can get some statistics on how many people with hepatitis progress to end-stage liver disease, particularly with reference to genotype, age, ALT/AST, etc.?

Thanks!

Mike

[pvk]

Thanks for posting that, mikesimon.  Although I don't understand the details, it appears to be positive news.  Can anyone explain the numbers?  For example, if the estimated annual mean transition F0>F1 is 0.117, is that saying that 11.7% of the people with F0 today will be F1 in a year?  Or, does it mean that it will take eight to nine years on the average to go from F0 to F1?  Just wondering...

[mikesimon]

That is better than I usually see. That is why I posted it. Since we can't really know how it is going to go we may as well look at favorable information. We might feel a little better. I hope so anyway.
Mike

[mike716]

Gee, I wouldn't know what to do without a Markov maximum likelihood estimation method and a meta-analysis. And boy am I glad that the impact of potential covariates was evaluated using meta-regression. Of course the estimated annual mean stage-specific transition probabilities were based on the random effects model. What else?

So, the prevalence of cirrhosis after 20 years is 16%, 18%, or 7%? That sure is good bad news. Or bad good news, if you like.

I sure gotta hand it to those researchers for providing "increased precision in estimating fibrosis progression". Yippee!

M.

[mikesimon]

It's all a mystery but everything will be revealed in time - if we're just patient. Mike

[mike716]

"Other studies have provided mixed results, indicating both favorable and poor long term prognosis from chronic hepatitis C virus infection"

I'll say they're mixed. "Mixed up" is maybe more like it. Who does these so-called studies? Who controls them? Is this science, or the numbers racket? "Hey, Vito, what's da odds on F4 at fifty? Ya handicappin it? Yeah, yeah, I saw dat story in the Pamona Hepatitis Scratch Sheet, we put dat in there ta get the odds down, sure. Okay, give 'em twenny ta one, but I don't wanna hear no krap from da losers, ya unnerstand me, youse guys? Cause if de odds are fixed it ain't my fault, I'm jus runnin da book."

M.

[mikesimon]

Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: A meta-analysis and meta-regression.
Thein HH, Yi Q, Dore GJ, Krahn MD.

University Health Network, Division of Clinical Decision‐Making and Health Care Research, Toronto, Ontario, Canada.

Published estimates of liver fibrosis progression in individuals with chronic hepatitis C virus (HCV) infection are heterogeneous. We aimed to estimate stage-specific fibrosis progression rates and their determinants in these individuals. A systematic review of published prognostic studies was undertaken. Study inclusion criteria were as follows: (1) presence of HCV infection determined by serological assays; (2) available information about age at assessment of liver disease or HCV acquisition; (3) duration of HCV infection; and (4) histological and/or clinical diagnosis of cirrhosis. Annual stage-specific transition probabilities (F0-->F1, ... , F3-->F4) were derived using the Markov maximum likelihood estimation method and a meta-analysis was performed. The impact of potential covariates was evaluated using meta-regression. A total of 111 studies of individuals with chronic HCV infection (n = 33,121) were included. Based on the random effects model, the estimated annual mean (95% confidence interval) stage-specific transition probabilities were: F0-->F1 0.117 (0.104-0.130); F1-->F2 0.085 (0.075-0.096); F2-->F3 0.120 (0.109-0.133); and F3-->F4 0.116 (0.104-0.129). The estimated prevalence of cirrhosis at 20 years after the infection was 16% (14%-19%) for all studies, 18% (15%-21%) for cross-sectional/retrospective studies, 7% (4%-14%) for retrospective-prospective studies, 18% (16%-21%) for studies conducted in clinical settings, and 7% (4%-12%) for studies conducted in nonclinical settings. Duration of infection was the most consistent factor significantly associated with progression of fibrosis. Conclusion: Our large systematic review provides increased precision in estimating fibrosis progression in chronic HCV infection and supports nonlinear disease progression. Estimates of progression to cirrhosis from studies conducted in clinical settings were lower than previous estimates. (HEPATOLOGY 2008.).