Abstract
The management of patients with chronic hepatitis C (CHC) depends on their clinical stage. Thus, noninvasive early recognition of patients with CHC at high risk for developing liver-related events (LREs) is important because it ensures optimal preventative management strategies may be employed that can affect the course of CHC disease. Our aim was to determine whether liver stiffness measurement (LSM) in hepatitis C virus (HCV)-infected patients is associated with a risk of LREs, particularly in cirrhotic patients. We carried out a retrospective study on 343 HCV-infected patients stratified according to cirrhosis (LSM<12.5 kPa vs. LSM≥12.5 kPa), and the cirrhotic patient group (LSM≥12.5 kPa) was divided according to risk of esophageal varices (LSM <25 kPa vs. LSM≥25 kPa). For all patients, each incremental unit in the natural logarithm (Ln) of LSM was associated with 14.76 times higher risk of developing LREs (p<0.001). Patients with cirrhosis (LSM≥12.5 kPa) had a higher risk of LREs than patients without cirrhosis (LSM<12.5 kPa) [adjusted hazard ratio (aHR) = 30.97; p<0.001]. When only cirrhotic patients were analyzed (n = 60), each incremental unit in the Ln of LSM was associated with 10.56 times higher risk of developing LREs (p = 0.010). Patients with LSM≥25 kPa had a greater risk for LRE development compared to those with LSM<25 kPa (aHR = 3.65; p = 0.045). The AUROC for predicting the onset of LREs was 0.876 in all patients and 0.729 in cirrhotic patients. In conclusion, LSM was associated with an increased risk of developing LREs in HCV-infected patients, even within the group of cirrhotic patients.
Highlights
200 million people worldwide are chronically infected with hepatitis C virus (HCV), which leads to the development of chronic liver disease or liver-related death [1,2]
Our findings indicate that liver stiffness measurement (LSM) was associated with an increased hazard of developing the first episode of liverrelated events (LREs) in HCV-infected patients and, LSM may be a valid noninvasive test for stratifying the risk for developing LREs in patients with chronic hepatitis C (CHC)
Hazard of liver-related events in HCV-infected patients according to the liver stiffness measurement (LSM)
Summary
200 million people worldwide are chronically infected with hepatitis C virus (HCV), which leads to the development of chronic liver disease or liver-related death [1,2]. Liver cirrhosis is characterized by a compensated stage (stage 4 fibrosis with or without esophageal varices) followed by a decompensated stage, which can involve complications (variceal bleeding, hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, and/or hepatorenal syndrome), hepatocellular carcinoma, liver transplantation, and liver-related death [4,5]. Sustained virological response (SVR) with antiviral therapy may reduce the clinical consequences of CHC, but patients with cirrhosis, despite HCV eradication, remain at risk of disease progression [8]
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