Journal of Gastroenterology

, Volume 45, Issue 6, pp 636–645 | Cite as

Chronic hepatitis C increased the mortality rates of patients with hepatocellular carcinoma and diabetes mellitus in a triple hepatitis virus endemic community

  • Kuo-Chin Chang
  • Pei-Shan Tsai
  • Mei-Chin Hsu
  • Shu-Fen Hung
  • Chin-Chen Tsai
  • Sheng-Nan LuEmail author
Original Article—Liver, Pancreas, and Biliary Tract



To elucidate the factors associated with mortality rates among older subjects with hepatocellular carcinoma (HCC) and diabetes mellitus (DM) in a triple hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV) endemic community.


A total of 2,909 residents aged ≥45 years were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV) and alanine aminotransaminase (ALT) in 1997. Anti-HDV was detected in HBsAg-positive subjects. Those who expired from HCC and DM were identified from official mortality data sets (1997–2003). Survival was analyzed using the Kaplan–Meier survival curve with log-rank test and the Cox proportional hazard model.


Forty-one patients died of HCC and 25 of DM during the study period. Multivariate analysis indicated that age ≥65 years (hazard ratio 3.4; 95% confidence interval 1.8–6.4), HBsAg (3.3; 1.7–6.7), anti-HCV (3.8; 1.7–8.5) and ALT ≥40 IU/L (3.7; 1.9–7.0) were independent predictors of HCC mortality, while age ≥65 years (4.8; 2.1–11.0) and anti-HCV (4.2; 1.7–10.6) were two independent predictors of DM mortality. There were synergistic effects of dual viral infections for HCC, but not for DM mortality.


Old age and chronic HCV infection increase the risk of HCC and DM mortality. HBsAg and ALT levels are also risk factors for HCC mortality, but not DM. The synergistic effects of dual hepatitis viral infections are demonstrable and warrant further investigation.


Diabetes mellitus Hepatitis B virus Hepatitis C virus Hepatocellular carcinoma Mortality 



This study was supported by a grant to Dr. S.N. Lu from the National Science Council of the Republic of China (NSC 92-2314-B-182-065).


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Copyright information

© Springer 2010

Authors and Affiliations

  • Kuo-Chin Chang
    • 1
  • Pei-Shan Tsai
    • 2
  • Mei-Chin Hsu
    • 1
  • Shu-Fen Hung
    • 1
  • Chin-Chen Tsai
    • 2
  • Sheng-Nan Lu
    • 1
    Email author
  1. 1.Division of Hepato-Gastroenterology, Department of Internal MedicineChang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Health Center of Zihkuan TownshipKaohsiungTaiwan

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