Dynamic monitoring with shear wave elastography predicts outcomes of chronic hepatitis B patients with decompensated cirrhosis.

Abstract

BackgroundTwo-dimensional shear wave elastography (2D-SWE) can be used to accurately assess significant liver fibrosis in chronic hepatitis B (CHB). However, whether those with decompensated cirrhosis could benefit from surveillance with 2D-SWE remains unclear. We aimed to evaluate the association between dynamic changes in 2D-SWE measurements and the prognosis of CHB-related decompensated cirrhosis.MethodsWe prospectively enrolled 149 consecutive treatment-naive CHB patients with decompensated cirrhosis from a clinical trial (registration number: ChiCTR-DCD-15006000) from February 2015 to December 2018. 2D-SWE was performed at 48-week intervals until December 2020. Liver-related events (LREs) were recorded through electronic medical records and telephone interviews.ResultsThe liver stiffness measurement (LSM) levels persistently reduced after antiviral therapy in patients who did not develop LREs, while patients with LREs showed a fluctuating trend of LSM alterations. Low pre-treatment 2D-SWE LSM, ∆% 2D-SWE LSM pre-virus control, and ∆% 2D-SWE LSM pre-post treatment were characterized by similar prognostic abilities as high levels of these parameters. Post-treatment 2D-SWE LSM was independently correlated with LREs in multivariate Cox regression models after antiviral treatments [hazard ratio (HR) =1.05; 95% confidence interval (CI): 1.02–1.08, P=0.0007 and 1.11; 95% CI: 1.04–1.18, P=0.0026]. Receiver operating characteristic (ROC) curve analysis identified that post-treatment 2D-SWE LSM exhibited the best predictive power for LREs among all the other variables, including parameters of 2D-SWE and serum fibrosis markers (area under the curve =0.75, P<0.001).ConclusionsThe last follow-up LSM, rather than pre-treatment or dynamic changes in 2D-SWE serves as a powerful predictor of LREs, suggesting that sequential monitoring may be beneficial to predicting prognosis.