Prognostic factors in patients with hepatitis C virus infection and systemic vasculitis

Abstract

Objective: Hepatitis C virus (HCV)-related systemic vasculitis can cause significant morbidity and mortality. Most studies of the prognosis of patients with HCV-related systemic vasculitis are based on heterogeneous studies performed before the era of antiviral therapy. The aim of this study was to analyze the clinical, biologic, and therapeutic factors associated with prognosis in a homogeneous series of patients with HCV-related systemic vasculitis who were followed up during the era of antiviral therapy.

Methods: One hundred fifty-one consecutive HCV RNA-positive patients with vasculitis were prospectively followed up between 1993 and 2009 and were analyzed for clinical, biologic, and therapeutic factors associated with survival.

Results: After a median followup period of 54 months, 32 patients (21%) had died, mainly of infection and end-stage liver disease. The 1-year, 3-year, 5-year, and 10-year survival rates were 96%, 86%, 75%, and 63%, respectively. Baseline factors associated with a poor prognosis were the presence of severe liver fibrosis (hazard ratio [HR] 5.31), central nervous system involvement (HR 2.74), kidney involvement (HR 1.91), and heart involvement (HR 4.2). The Five-Factors Score (FFS), a vasculitis scoring system, was significantly associated with outcome. In multivariate analysis, severe fibrosis (HR 10.8) and the FFS (HR 2.49) were significantly associated with a poor prognosis. Treatment with the combination of PEGylated interferon plus ribavirin was associated with a good prognosis (HR 0.34), whereas treatment with immunosuppressive agents was associated with a poor outcome, after adjustment for the severity of vasculitis (HR 4.05). Among patients without severe fibrosis, the FFS was a good predictor of outcome, while among those with severe fibrosis, the severity of vasculitis had no prognostic value.

Conclusion: At the time of the diagnosis of HCV-related systemic vasculitis, severe liver fibrosis and the severity of vasculitis were the main prognostic factors. Use of antiviral agents was associated with a good prognosis, whereas treatment with immunosuppressant agents had a negative impact.