Abstract
The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30–6.95), p = 0.010], baseline albumin < 3.5 mg/dL [HR = 4.49 (1.95–10.34), p < 0.001] and baseline unfavorable Baveno-VI [HR = 4.72 (1.32–16.83), p = 0.017] were independently associated and LSM regression ≥ 20% after SVR had a trend to reduce the risk of LRC or death [HR = 0.45 (0.21–1.02), p = 0.058]. The use of simple parameters before DAAs and repetition of LSM post-SVR can identify patients with different risks for severe outcome after HCV eradication.
Highlights
Direct-acting antivirals (DAA) have changed the natural history of chronic hepatitis C in the last decade[1]
A total of 1,131 patients with chronic hepatitis C were treated by DAA in two tertiary centers of Rio de Janeiro (Brazil) from October 2015 to November 2019
The current study highlighted that albumin levels lower than 3.5 mg/dL and/or presence of unfavorable Baveno VI status (LSM ≥ 20 kPa or platelet count < 150 × 109/mm3) before hepatitis C virus (HCV) treatment were associated with an increased risk of liver related complications (LRC) or death after sustained virological response (SVR) adjusted for confounding factors in patients with compensated advanced chronic liver disease (c-ACLD)
Summary
Direct-acting antivirals (DAA) have changed the natural history of chronic hepatitis C in the last decade[1]. Liver biopsy remains the reference for liver fibrosis staging and detection of cirrhosis This invasive method has been challenged by several limitations and performing a liver biopsy in SVR patients without abnormal liver tests might not be justified. Several recent studies have reported a significant regression of LSM after SVR in patients with HCV treated by D AAs11,12. The extent of the long-term clinical impact of LSM reduction after SVR in patients with HCV treated by DAAs remains unclear because most trials had short follow-up periods and such severe outcomes are rare. The primary aim of this study was to evaluate the prognostic value of LSM regression after SVR by DAAs. The secondary aim was to identify risk factors associated with liver related complications (LRC) or death in patients with HCV after SVR
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