FIB-4 value before DAA therapy as a predictor of Esophageal varices progression after SVR12 with DAA therapy

Abstract

Objective: The goals of this study were to better understand the impact that direct-acting antivirals (DAAs) have on portal hypertension once a sustained viral response (SVR) has been achieved. Therefore, it is important to look at economical and noninvasive predictors. We looked into the factors that contributed to the emergence of EVs in hepatitis C infected patients after SVR with DAAs.
 Study Design: Open-Label Single-Arm clinical trial
 Setting: Department of Gastroenterology, AIMC/ Jinnah Hospital, Lahore
 Duration of Study: The duration of study was 3 years and 4 months ( from June 2017 to October 2020)
 Methods: 109 patients who attained SVR post DAA therapy were enrolled in this study and their pre- and post-treatment esophagogastroduodenoscopy (EGD) findings were compared. EV progression and non-progression were assessed. Additionally, EV cumulative advancement rates were examined.
 Results: Before DAA treatment, the fibrosis-4 index (FIB-4) was the only substantial predictor of EVs progression after SVR ( 95% confidence intervals: 1.25-1.54, odds ratios: 1.45, p = 0.02). Based on ROC curve analysis, patients with a FIB-4 of 8.5 or higher had a higher risk of EVs (sensitivity = 0.69, specificity = 0.91, positive predictive value = 0.36, negative predictive value = 0.98).
 Conclusion: EV development is possible in patients with FIB-4≥ 8.5, so EGD surveillance should continue after SVR.
 Keywords: 
 Hepatitis C, EV, Esophageal varices, Direct acting antivirals, Sustained viral response, FIB-4