Prediction of Clinical Trajectory in HCV-Related ACLD after SVR: Role of Liver Stiffness in a 5-Years Prospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Target Population
2.2. Follow-Up and Measurements
2.3. Liver Stiffness Measurement
2.4. Study Outcomes
- -
- New onset of: (1) ascites; (2) variceal bleeding; (3) spontaneous bacterial peritonitis; (4) hepatic encephalopathy; (5) liver transplantation: (6) death for Child–Pugh A and B patients;
- -
- Occurrence of de novo HCC;
- -
- In Child–Pugh B patients, worsening of a pre-existing symptom of decompensated cirrhosis (i.e., need for an increased dose of diuretics, addition of rifaximin for hepatic encephalopathy, or hospital admission for a new liver failure event) were also considered as LRE.
2.5. Statistical Analysis
3. Results
3.1. Patients’ Characteristics
3.2. Incidence of Liver-Related Events
3.3. Basal Predictors of Liver-Related Events
3.4. Dynamics of Liver Stiffness Measurements
4. Discussion
- SVR patients at the highest likelihood of lack of LRE are females and those with basal LSM < 20 kPa who have a 10-fold lower incidence of LRE at 5 years after SVR as compared to males and those with a basal LSM ≥ 20 kPa.
- The magnitude of fibrosis regression in SVR patients without LRE at 5 years depends on the basal LSM; results are higher in patients with more severe liver fibrosis at baseline. The reduction of LSM, at 5 years after SVR, is between 18.08% and 37.2%.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | n (%) | |
---|---|---|
575 | ||
Sex | Male | 305 (53.0) |
Female | 270 (47.0) | |
Sex ratio | M/F | 1.1 |
Age, years | ≤50 | 83 (14.4) |
51–65 | 196 (34.1) | |
>65 | 296 (51.5) | |
Mean age ± SD | 64.1 ± 12.0 | |
Previous IFN treatment | ||
Yes | 296 (51.5) | |
No | 279 (48.5) | |
Child–Pugh * | ||
A | 543 (94.4) | |
B | 32 (5.6) | |
LSM (kPa) ** | <20 | 390 (71.3) |
≥20 | 157 (28.7) | |
Mean LSM ± SD § | 19.2 ± 7.6 | |
Genotype | 1 | 459 (79.8) |
other | 116 (20.2) | |
DAAs Therapy | SOF | 45 (7.8) |
SOF + other | 373 (72.7) | |
3D | 132 (23.0) | |
2D | 9 (1.6) | |
other | 16 (2.8) | |
Ribavirin | Yes | 222 (38.6) |
No | 353 (61.4) |
Events | n | Incidence Rate per 100 p/y (95% CI) |
---|---|---|
Overall death | 51 | 1.9 (1.4–2.5) |
Death for hepatic causes | 17 | 0.6 (0.4–1.0) |
Death for non-hepatic causes | 34 | 1.3 (0.9–1.8) |
Any liver decompensation * | 43 | 1.6 (1.2–2.2) |
HCC # | 41 | 1.6 (1.2–2.2) |
Liver transplantation | 3 | 0.1 (0.0–0.3) |
Any event § | 98 | 3.9 (3.2–4.7) |
Liver Decompensation | HCC | ||||||||
---|---|---|---|---|---|---|---|---|---|
Characteristics | HRcrude (95% IC) | p | HRadj (95% IC) | p | HRcrude (95% IC) | p | HRadj (95% IC) | p | |
Sex | F | 1 | 1 | ||||||
M | 1.0 (0.5–1.8) | 0.969 | 2.5 (1.3–5.1) | 0.008 | 3.6 (1.6–8.0) | 0.002 | |||
Age (y) | <65 | 1 | 1 | 1 | |||||
≥65 | 2.8 (1.4–5.7) | 0.005 | 2.2 (1.0–4.9) | 0.053 | 2.2 (1.1–4.2) | 0.026 | 2.0 (1.0–4.2) | 0.060 | |
Child-Pugh | A | 1 | 1 | 1 | |||||
B | 4.7 (2.1–10.5) | <0.001 | 1.3 (0.4–4.4) | 0.635 | 2.6 (0.9–7.3) | 0.075 | 2.1 (0.7–6.1) | 0.169 | |
LSM (kPa) | <20 | 1 | 1 | 1 | |||||
≥20 | 14.8 (5.7–38.4) | <0.001 | 13.5 (5.2–35.3) | <0.001 | 10.7 (4.6–24.5) | <0.001 | 9.2 (4.0–21.3) | <0.001 | |
Genotype | 1 | 1 | 1 | ||||||
other | 0.8 (0.4–1.8) | 0.661 | 0.9 (0.4–2.1) | 0.831 |
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Morisco, F.; Federico, A.; Marignani, M.; Lombardo, F.L.; Cossiga, V.; Ranieri, L.; Romeo, M.; Cipullo, M.; Begini, P.; Zannella, A.; et al. Prediction of Clinical Trajectory in HCV-Related ACLD after SVR: Role of Liver Stiffness in a 5-Years Prospective Study. Viruses 2024, 16, 1439. https://doi.org/10.3390/v16091439
Morisco F, Federico A, Marignani M, Lombardo FL, Cossiga V, Ranieri L, Romeo M, Cipullo M, Begini P, Zannella A, et al. Prediction of Clinical Trajectory in HCV-Related ACLD after SVR: Role of Liver Stiffness in a 5-Years Prospective Study. Viruses. 2024; 16(9):1439. https://doi.org/10.3390/v16091439
Chicago/Turabian StyleMorisco, Filomena, Alessandro Federico, Massimo Marignani, Flavia L. Lombardo, Valentina Cossiga, Luisa Ranieri, Mario Romeo, Marina Cipullo, Paola Begini, Alessandra Zannella, and et al. 2024. "Prediction of Clinical Trajectory in HCV-Related ACLD after SVR: Role of Liver Stiffness in a 5-Years Prospective Study" Viruses 16, no. 9: 1439. https://doi.org/10.3390/v16091439