Post on 12-Jul-2020
Según clasificación clínica
-Descompensada: ascitis, hemorragia digestiva, encefalopatía, PBE, e ictero
Según estadios de Child-Pugh
-Descompensada: Child-Pugh ≥ 7
Según clasificación de DAmico (1996):
Antiviral treatment DAAsAntioxidantes
-Probabilidad de supervivencia
-Incidencia acumulada de HCC
-Incidencia acumulada de complicaciones
* Hemorragia digestiva
* Ascitis
* Encefalopatía
* Peritonitis bacteriana espontánea
* Síndrome hepatorrenal
CIRROSIS
Stage 2
Stage 1
SubHazard ratio for stage 2= 4.4 (95% CI: 2.4 - 8.2), P<0.0001
0
10
20
30
40
50
Cum
ula
tive In
cid
en
ce o
f liv
er-
rela
ted
mo
rta
lity
or
tra
nsp
lant (%
)
0 26 52 78 104 130 156 182 208 234 260 286 312
Weeks
No. at risk
Stage1 294 288 286 244 228 204 184 160 144 120 98 72 60
Stage2 108 106 104 86 78 62 50 30 28 22 14 10 8
Stage 2
Stage 1
SubHazard ratio for stage 2= 3.6 (95% CI: 1.8 - 7.5), P<0.0001
0
10
20
30
40
50
Cum
ula
tive In
cid
en
ce o
f H
CC
(%
)
0 26 52 78 104 130 156 182 208 234 260 286 312
WeeksNo. at risk
Stage1 294 286 284 238 224 200 182 158 144 116 96 70 58
Stage2 108 104 102 82 74 62 50 30 26 20 12 10 8
0
10
20
30
40
50
Cum
ula
tive In
cid
en
ce o
f va
rice
al d
eve
lopm
ent (%
)
0 26 52 78 104 130 156 182 208 234 260 286 312
Weeks
No. at risk
Stage1 294 294 294 254 254 150 150 122 120 68 68 48 48
Stage 2
Stage 1
Subhazard ratio for stage 2= 3.5 (95% CI: 2.3 - 5.3), P<0.0001
0
10
20
30
40
50
60
70
80
90
100
Cum
ula
tive In
cid
en
ce o
f cl
inic
al d
eco
mp
en
satio
n (
%)
0 26 52 78 104 130 156 182 208 234 260 286 312
WeeksNo. at risk
Stage1 294 288 280 234 220 188 174 152 138 110 92 68 56
Stage2 108 104 102 82 72 48 38 20 18 10 6 4 4
Stage 2
Stage 1
SubHazard ratio for stage 2= 2.6 (95% CI: 1.6 - 4.4), P<0.0001
0
10
20
30
40
50
Cum
ula
tive In
cid
en
ce o
f a
scites (
%)
0 26 52 78 104 130 156 182 208 234 260 286 312
WeeksNo. at risk
Stage1 294 288 280 234 220 190 176 154 136 110 92 68 58
Stage2 108 104 102 82 72 56 44 24 22 14 8 6 4
Stage 1
Stage 2
SubHazard ratio for stage 2= 15.9 (95% CI: 5.9 - 42.6), P<0.0001
01
02
03
04
05
0
Cum
ula
tive In
cid
en
ce o
f va
rice
al h
em
orr
ha
ge
(%
)
0 26 52 78 104 130 156 182 208 234 260 286 312
WeeksNo. at risk
Stage1 294 288 286 242 228 202 182 158 144 118 98 72 58
Stage2 108 106 104 86 78 58 48 26 24 18 10 6 6
Stage 1
Stage 2
SubHazard ratio for stage 2= 2.5 (95% CI: 1.1 - 5.9), P=0.035
0
10
20
30
Cum
ula
tive In
cid
en
ce o
f e
nce
ph
alo
path
y (%
)
0 26 52 78 104 130 156 182 208 234 260 286 312
WeeksNo. at risk
Stage1 294 288 284 238 224 198 178 154 142 118 98 72 60
Stage2 108 106 104 86 78 60 50 28 26 20 14 10 8
Stage 2
Stage 1
SubHazard ratio for stage 2= 1.4 (95% CI: 0.3 - 6.8), P=0.66
0
1
2
3
4
5
6
7
8
9
10
Cum
ula
tive In
cid
en
ce o
f S
BP
(%
)
0 26 52 78 104 130 156 182 208 234 260 286 312
WeeksNo. at risk
Stage1 294 286 284 238 226 200 180 156 144 118 98 72 60
Stage2 108 106 104 86 78 64 52 30 28 22 14 10 8
Stage 2
Stage 1
SubHazard ratio for stage 2= 1.6 (95% CI: 0.8 - 3.3), P=0.21
0
5
10
15
20
25
30
Cum
ula
tive In
cid
en
ce o
f ja
und
ice
(%
)
0 26 52 78 104 130 156 182 208 234 260 286 312
Weeks
No. at risk
Stage1 294 288 280 236 220 188 174 152 138 110 92 68 56
Stage2 108 104 102 82 72 48 38 20 18 10 6 4 4
HALT-C NEJM 2008
Effect of peginterferon on major clinical outcomes in pts with HCV-related cirrhosis
EPIC. Gastroenterology2011
Effect of peginterferon on major clinical outcomes in pts with HCV-related cirrhosis
Extended-HALT C. Hepatology2011
Extended effect of peginterferon on major clinical outcomes in HCV-related cirrhosis
Extended-HALT C. Gastroenterology2011
HALT-C
Extended effect of peginterferon on major clinical outcomes in HCV-related cirrhosis
Extended-HALT C. Hepatology 2011
HALT-C
Extended effect of peginterferon on overall mortality in HCV-related cirrhosis
Extended-HALT C. Hepatology 2011
Extended effect of peginterferon on overall mortality in HCV-related cirrhosis
Extended-HALT C. Hepatology 2011
Extended effect of peginterferon on overall mortality in HCV-related cirrhosis
Extended-HALT C. Hepatology 2011
Extended effect of peginterferon on overall mortality in HCV-related cirrhosis
Effect of peginterferon on overall mortality in decompensated HCV-related cirrhosis
Iacobellis. J Hepatol 2007
Incidence of adverse events during peginterferon treatment
Iacobellis. J Hepatol 2007
Vilar y cols. BMJ 2011
Effect of viusid on major clinical outcomes in pts with decompensated HCV-related cirrhosis
Vilar y cols. BMJ 2011
Effect of viusid on major clinical outcomes in pts with HCV-related cirrhosis