Natural History and Clinical Impact of Cryoglobulins in Chronic Hepatitis C: 10-Year Prospective Study of 343 Patients

Mauro Viganò, Pietro Lampertico, Maria Grazia Rumi, Christian Folli, Lorena Maggioni, Alberto Morabito, Ersilio Del Ninno, Marco Cicardi, Massimo Colombo

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Abstract

Background & Aims: Serum cryoglobulins (CGs) are present in patients with chronic hepatitis C virus (HCV) infection, but their long-term clinical importance has not been established. We assessed the development rates, morbidity, and influence on the evolutionary course of hepatitis C of CG. Methods: A cohort of 343 HCV-RNA seropositive outpatients (173 men; age, 58 y; 82 with cirrhosis; 61 treated with interferon) with persistently increased aminotransferase levels and histologically defined liver disease was investigated. Patients initially were investigated for the presence, amount, and type of CG and prospectively followed up with clinical and laboratory examinations every 6 months. Results: At enrollment, CGs were found in 163 (47%) patients at a mean level of 173 ± 142 mg/L; 80% were type III, and associated to female sex (61% vs 40%, P = .0002) and cirrhosis (29% vs 19%, P = .04). Over the course of 17-130 months (median, 116 mo), de novo CG developed in 25 patients (2.3% per year), including 5 with cryoglobulinemic syndrome (.3% per year). The 10-year rates of progression to cirrhosis and of liver and extrahepatic complications were similar in CG (+) and CG (-) patients (32% vs 34%; 23% vs 16%; 5% vs 3%). The 10-year survival rates were lower for cirrhotic than for noncirrhotic patients (57% vs 91%, P <.00001), independently of CGs. Conclusions: CGs are common in patients with chronic HCV infection, mainly are type III, and do not influence the clinical course of hepatitis C during the first decades, except for the few rare cases of cryoglobulinemic syndrome.

Original languageEnglish
Pages (from-to)835-842
Number of pages8
JournalGastroenterology
Volume133
Issue number3
DOIs
Publication statusPublished - Sep 2007

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Cryoglobulins
Chronic Hepatitis C
Natural History
Prospective Studies
Hepacivirus
Virus Diseases
Hepatitis C
Fibrosis
Transaminases
Liver Cirrhosis
Interferons
Liver Diseases
Outpatients
Survival Rate
RNA
Morbidity

ASJC Scopus subject areas

  • Gastroenterology

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Natural History and Clinical Impact of Cryoglobulins in Chronic Hepatitis C : 10-Year Prospective Study of 343 Patients. / Viganò, Mauro; Lampertico, Pietro; Rumi, Maria Grazia; Folli, Christian; Maggioni, Lorena; Morabito, Alberto; Del Ninno, Ersilio; Cicardi, Marco; Colombo, Massimo.

In: Gastroenterology, Vol. 133, No. 3, 09.2007, p. 835-842.

Research output: Contribution to journalArticle

Viganò, Mauro ; Lampertico, Pietro ; Rumi, Maria Grazia ; Folli, Christian ; Maggioni, Lorena ; Morabito, Alberto ; Del Ninno, Ersilio ; Cicardi, Marco ; Colombo, Massimo. / Natural History and Clinical Impact of Cryoglobulins in Chronic Hepatitis C : 10-Year Prospective Study of 343 Patients. In: Gastroenterology. 2007 ; Vol. 133, No. 3. pp. 835-842.
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abstract = "Background & Aims: Serum cryoglobulins (CGs) are present in patients with chronic hepatitis C virus (HCV) infection, but their long-term clinical importance has not been established. We assessed the development rates, morbidity, and influence on the evolutionary course of hepatitis C of CG. Methods: A cohort of 343 HCV-RNA seropositive outpatients (173 men; age, 58 y; 82 with cirrhosis; 61 treated with interferon) with persistently increased aminotransferase levels and histologically defined liver disease was investigated. Patients initially were investigated for the presence, amount, and type of CG and prospectively followed up with clinical and laboratory examinations every 6 months. Results: At enrollment, CGs were found in 163 (47{\%}) patients at a mean level of 173 ± 142 mg/L; 80{\%} were type III, and associated to female sex (61{\%} vs 40{\%}, P = .0002) and cirrhosis (29{\%} vs 19{\%}, P = .04). Over the course of 17-130 months (median, 116 mo), de novo CG developed in 25 patients (2.3{\%} per year), including 5 with cryoglobulinemic syndrome (.3{\%} per year). The 10-year rates of progression to cirrhosis and of liver and extrahepatic complications were similar in CG (+) and CG (-) patients (32{\%} vs 34{\%}; 23{\%} vs 16{\%}; 5{\%} vs 3{\%}). The 10-year survival rates were lower for cirrhotic than for noncirrhotic patients (57{\%} vs 91{\%}, P <.00001), independently of CGs. Conclusions: CGs are common in patients with chronic HCV infection, mainly are type III, and do not influence the clinical course of hepatitis C during the first decades, except for the few rare cases of cryoglobulinemic syndrome.",
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T1 - Natural History and Clinical Impact of Cryoglobulins in Chronic Hepatitis C

T2 - 10-Year Prospective Study of 343 Patients

AU - Viganò, Mauro

AU - Lampertico, Pietro

AU - Rumi, Maria Grazia

AU - Folli, Christian

AU - Maggioni, Lorena

AU - Morabito, Alberto

AU - Del Ninno, Ersilio

AU - Cicardi, Marco

AU - Colombo, Massimo

PY - 2007/9

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N2 - Background & Aims: Serum cryoglobulins (CGs) are present in patients with chronic hepatitis C virus (HCV) infection, but their long-term clinical importance has not been established. We assessed the development rates, morbidity, and influence on the evolutionary course of hepatitis C of CG. Methods: A cohort of 343 HCV-RNA seropositive outpatients (173 men; age, 58 y; 82 with cirrhosis; 61 treated with interferon) with persistently increased aminotransferase levels and histologically defined liver disease was investigated. Patients initially were investigated for the presence, amount, and type of CG and prospectively followed up with clinical and laboratory examinations every 6 months. Results: At enrollment, CGs were found in 163 (47%) patients at a mean level of 173 ± 142 mg/L; 80% were type III, and associated to female sex (61% vs 40%, P = .0002) and cirrhosis (29% vs 19%, P = .04). Over the course of 17-130 months (median, 116 mo), de novo CG developed in 25 patients (2.3% per year), including 5 with cryoglobulinemic syndrome (.3% per year). The 10-year rates of progression to cirrhosis and of liver and extrahepatic complications were similar in CG (+) and CG (-) patients (32% vs 34%; 23% vs 16%; 5% vs 3%). The 10-year survival rates were lower for cirrhotic than for noncirrhotic patients (57% vs 91%, P <.00001), independently of CGs. Conclusions: CGs are common in patients with chronic HCV infection, mainly are type III, and do not influence the clinical course of hepatitis C during the first decades, except for the few rare cases of cryoglobulinemic syndrome.

AB - Background & Aims: Serum cryoglobulins (CGs) are present in patients with chronic hepatitis C virus (HCV) infection, but their long-term clinical importance has not been established. We assessed the development rates, morbidity, and influence on the evolutionary course of hepatitis C of CG. Methods: A cohort of 343 HCV-RNA seropositive outpatients (173 men; age, 58 y; 82 with cirrhosis; 61 treated with interferon) with persistently increased aminotransferase levels and histologically defined liver disease was investigated. Patients initially were investigated for the presence, amount, and type of CG and prospectively followed up with clinical and laboratory examinations every 6 months. Results: At enrollment, CGs were found in 163 (47%) patients at a mean level of 173 ± 142 mg/L; 80% were type III, and associated to female sex (61% vs 40%, P = .0002) and cirrhosis (29% vs 19%, P = .04). Over the course of 17-130 months (median, 116 mo), de novo CG developed in 25 patients (2.3% per year), including 5 with cryoglobulinemic syndrome (.3% per year). The 10-year rates of progression to cirrhosis and of liver and extrahepatic complications were similar in CG (+) and CG (-) patients (32% vs 34%; 23% vs 16%; 5% vs 3%). The 10-year survival rates were lower for cirrhotic than for noncirrhotic patients (57% vs 91%, P <.00001), independently of CGs. Conclusions: CGs are common in patients with chronic HCV infection, mainly are type III, and do not influence the clinical course of hepatitis C during the first decades, except for the few rare cases of cryoglobulinemic syndrome.

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