Progression of Biopsy-Measured Liver Fibrosis in Untreated Patients with Hepatitis C Infection Non-Markov Multistate Model Analysis 英文参考文献.docVIP

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Progression of Biopsy-Measured Liver Fibrosis in Untreated Patients with Hepatitis C Infection Non-Markov Multistate Model Analysis 英文参考文献.doc

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Progression of Biopsy-Measured Liver Fibrosis in Untreated Patients with Hepatitis C Infection Non-Markov Multistate Model Analysis 英文参考文献

ProgressionofBiopsy-MeasuredLiverFibrosisin UntreatedPatientswithHepatitisCInfection:Non- MarkovMultistateModelAnalysis PeterBacchetti1*,RossBoylan1,JacquieAstemborski2,3,HuiShen4,5,ShrutiH.Mehta3,DavidL. Thomas2,NorahA.Terrault4,6,AlexanderMonto4,5 1Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California,United States of America, 2Department of Medicine, JohnsHopkinsUniversity,Baltimore,Maryland,UnitedStatesofAmerica,3DepartmentofEpidemiology,JohnsHopkinsBloombergSchoolofPublicHealth,Baltimore, Maryland,UnitedStatesofAmerica,4DepartmentofMedicine,UniversityofCaliforniaSanFrancisco,SanFrancisco,California,UnitedStatesofAmerica, 5Divisionof Gastroenterology,SanFranciscoVeteransAffairsMedicalCenter,SanFrancisco,California,UnitedStatesofAmerica,6DepartmentofSurgery,UniversityofCaliforniaSan Francisco,SanFrancisco,California,UnitedStatesofAmerica Abstract Background:FibrosisstagesfromliverbiopsiesreflectliverdamagefromhepatitisCinfection,butanalysisischallenging duetotheirorderedbutnon-numericnature,infrequentmeasurement,misclassification,andunknowninfectiontimes. Methods:Weusedanon-Markovmultistatemodel,accountingformisclassification,withmultipleimputationofunknown infectiontimes,appliedto1062participantsofwhom159hadmultiplebiopsies.Oddsratios(OR)quantifiedtheestimated effectsofcovariatesonprogressionriskatanygiventime. Results: Models estimated that progression risk decreased the more time participants had already spent in the current stage,AfricanAmericanracewasprotective(OR0.75,95%confidenceinterval0.60to0.95,p=0.018),andoldercurrentage increasedrisk(OR1.33perdecade,95%confidenceinterval1.15to1.54,p=0.0002).Whencontrolledforcurrentage,older ageatinfectiondidnotappeartoincreaserisk(OR0.92perdecade,95%confidenceinterval0.47to1.79,p=0.80).There wasasuggestionthatco-infectionwithhumanimmunodeficiencyvirusincreasedriskofprogressionintheeraofhighly activeantiretroviraltreatmentbeginningin1996(OR2.1,95%co