All-Cause Mortality and Progression Risks to Hepatic Decompensation and Hepatocellular Carcinoma in Patients Infected With Hepatitis C Virus.

BACKGROUND: A key question in care of patients with chronic hepatitis C virus (HCV) infection is beginning treatment immediately vs delaying treatment. Risks of mortality and disease progression in "real world" settings are important to assess the implications of delaying HCV treatment. METHODS: This was a cohort study of HCV patients identified from 4 integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites, or portal hypertension) or liver transplant were estimated over 1, 2, or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation. RESULTS: Among 2799 HCV-monoinfected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated risk of progression to hepatic decompensation or hepatocellular carcinoma was 37.2% in stage F4, 19.6% in F3, 4.7% in F2, and 2.3% in F0-F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma. CONCLUSIONS: The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease.

Correlation of lineaments to ground water inflows in a bedrock tunnel.

Lineaments derived from three image types (1:80,000 black and white, 1:58,000 color infrared, and 1:250,000 side-looking airborne radar) were compared to water-bearing features within a 9.6 km section of tunnel being constructed through foliated crystalline metamorphic bedrock in a glaciated region of eastern Massachusetts. Lineaments drawn by three observers during two independent trials (N = 9137) were reduced to three sets (one per image type) of coincident lineaments (N = 794). Thirty-five coincident lineaments crossed the tunnel. Nineteen discrete flow zones, each producing > or = 19 L/min, were identified in the tunnel and used to quantify the reliability of lineament analysis as a method of predicting water-bearing features in glaciated metamorphic Thirteen (68%) of the flow zones correlate with coincident lineaments, six zones correlate with more than one image type, and one zone correlates with all three image types. Overall, without additional corroborating evidence, it is difficult to interpret in advance which lineaments will result in a successful correlation with water-producing zones in the subsurface and which ones will not. Most of the observed flow (80%) correlates with northwest-trending coincident lineaments; however, the majority of the flow (67%) associated with these lineaments is produced from structures that strike to the north or northeast. In addition, only 15 of the 35 coincident lineaments correlate with the flow zones, indicating that 20 lineaments are not associated with any appreciable flow. Six flow zones are undetected by the lineament analysis.