Impact of mixed cryoglobulinemia on patients with spontaneous hepatitis C virus clearance: A 13-year prospective cohort study.
Adult
Aged
Carcinoma, Hepatocellular
/ epidemiology
Cardiovascular Diseases
/ mortality
Case-Control Studies
Cognitive Dysfunction
/ epidemiology
Cohort Studies
Colonic Neoplasms
/ epidemiology
Complement C4
/ immunology
Cryoglobulinemia
/ epidemiology
Female
Heart Failure
/ epidemiology
Hepatitis C
/ epidemiology
Humans
Immunoglobulin G
/ immunology
Immunoglobulin M
/ immunology
Incidence
Leukemia, Myeloid, Acute
/ epidemiology
Liver Cirrhosis
/ epidemiology
Liver Neoplasms
/ epidemiology
Male
Middle Aged
Myocardial Ischemia
/ epidemiology
Myocardial Revascularization
/ statistics & numerical data
Neoplasms
/ epidemiology
Nervous System Diseases
/ epidemiology
Proportional Hazards Models
Prospective Studies
Prostatic Neoplasms
/ epidemiology
Remission, Spontaneous
Rheumatoid Factor
/ immunology
Sex Distribution
Stroke
/ epidemiology
cancer
hepatitis C virus clearance
mixed cryoglobulinemia
rheumatoid factor
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
05
03
2019
revised:
09
10
2019
accepted:
26
11
2019
pubmed:
30
11
2019
medline:
18
11
2020
entrez:
30
11
2019
Statut:
ppublish
Résumé
The prevalence and associations of mixed cryoglobulinemia (MC) in patients with spontaneous clearance of hepatitis C virus (HCV) remain elusive. A 13-year prospective cohort study of patients with spontaneous HCV clearance was conducted in a tertiary care centre. Baseline characteristics, incident cardiovascular and neurologic events and cancers were analysed. Of 104 consecutive patients (mean age: 54.08 years old; females: 71 [68%]), 37 (34.6%) had MC and 6 (5.8%) had cirrhosis. MC (+) patients were more female (86% vs 58%, P = .002), had higher rate of cirrhosis (14% vs 1.5%, P = .012), higher levels of Immunoglobulin G (IgG; P = .001), IgM (P = .002) and fibrosis-4 (FIB-4) (P = .004), but lower levels of complement C4 (P = .034) than the MC (-) patients. Female gender (95% confidence interval [CI] of odds ratio: 1.402-26.715), levels of IgG (1.000-1.004), IgM (1.009-1.037) and FIB-4 (1.217-3.966) were independently associated with MC. Baseline rheumatoid factor (RF) levels were independently associated with incident cancer (95% CI hazard ratio [HR]: 1.001-1.030 [HR: 1.015], P = .039). With a cut-off value of 11.3 IU/mL, RF levels significantly predicted incident cancer (area under curve: 0.865, P = .002). No different cumulative incidences of cardiovascular and neurologic events, cancers or mortalities were identified between MC (+) and MC (-) patient. Approximately 1/3 of patients with spontaneous HCV clearance yielded MC, which harboured similar characteristics of MC in patients with chronic hepatitis C. Despite the negligible role of MC in the prognosis of patients with spontaneous HCV clearance, the connection between RF and incident cancer demands further investigation.
Sections du résumé
BACKGROUND
BACKGROUND
The prevalence and associations of mixed cryoglobulinemia (MC) in patients with spontaneous clearance of hepatitis C virus (HCV) remain elusive.
MATERIALS AND METHODS
METHODS
A 13-year prospective cohort study of patients with spontaneous HCV clearance was conducted in a tertiary care centre. Baseline characteristics, incident cardiovascular and neurologic events and cancers were analysed.
RESULTS
RESULTS
Of 104 consecutive patients (mean age: 54.08 years old; females: 71 [68%]), 37 (34.6%) had MC and 6 (5.8%) had cirrhosis. MC (+) patients were more female (86% vs 58%, P = .002), had higher rate of cirrhosis (14% vs 1.5%, P = .012), higher levels of Immunoglobulin G (IgG; P = .001), IgM (P = .002) and fibrosis-4 (FIB-4) (P = .004), but lower levels of complement C4 (P = .034) than the MC (-) patients. Female gender (95% confidence interval [CI] of odds ratio: 1.402-26.715), levels of IgG (1.000-1.004), IgM (1.009-1.037) and FIB-4 (1.217-3.966) were independently associated with MC. Baseline rheumatoid factor (RF) levels were independently associated with incident cancer (95% CI hazard ratio [HR]: 1.001-1.030 [HR: 1.015], P = .039). With a cut-off value of 11.3 IU/mL, RF levels significantly predicted incident cancer (area under curve: 0.865, P = .002). No different cumulative incidences of cardiovascular and neurologic events, cancers or mortalities were identified between MC (+) and MC (-) patient.
CONCLUSIONS
CONCLUSIONS
Approximately 1/3 of patients with spontaneous HCV clearance yielded MC, which harboured similar characteristics of MC in patients with chronic hepatitis C. Despite the negligible role of MC in the prognosis of patients with spontaneous HCV clearance, the connection between RF and incident cancer demands further investigation.
Substances chimiques
Complement C4
0
Immunoglobulin G
0
Immunoglobulin M
0
Rheumatoid Factor
9009-79-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13189Subventions
Organisme : Chang Gung Medical Research Program
ID : CMRPG3F0473
Organisme : Chang Gung Medical Research Program
ID : CRRPG3F0013
Organisme : Chang Gung Medical Research Program
ID : CMRPG3I0411
Organisme : Chang Gung Medical Research Program
ID : CMRPG3H1911
Organisme : Chang Gung Medical Research Program
ID : CMRPG3J0811
Organisme : National Science Council, Taiwan
ID : MOST 106-2314-B-182-041-MY2
Organisme : National Science Council, Taiwan
ID : MOST 108-2314-B-182-051-
Informations de copyright
© 2019 Stichting European Society for Clinical Investigation Journal Foundation.
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