Post-treatment hepatic stiffness predicts complications, HCC in hepatitis C
SAN DIEGO — Assessing liver stiffness predicted liver-related complications and the development of hepatocellular carcinoma in patients with hepatitis C after direct-acting antiviral therapy, research shows.
“HCV infection is one of the leading causes of cirrhosis, HCC and liver-related complications. A sustained virologic response is achieved in 80% to 95% of patients with chronic HCV treated with direct-acting antivirals, or DAAs,” Prooksa Anancheunsook, MARYLAND, a gastroenterology faculty member from Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, told Digestive Disease Week 2022. “However, the risk of HCC and liver-related complications is not eliminated despite viral eradication.”
Seeking to identify predictors of HCC and the development of liver-related complications, Anancheunsook and colleagues analyzed 244 HCV patients who achieved a sustained virologic response (SVR) after DAA treatment at King Chulalongkorn Memorial Hospital in January 2015. to December 2019. Data collected at pretreatment and during the 12 months following SVR included patient characteristics, aspartate transaminase to platelet ratio index (APRI), fibrosis score-4 (FIB-4), and hepatic stiffness measured by transient elastography. The researchers defined SVR by undetectable HCV RNA 12 weeks after the end of treatment and the transient elastography threshold for advanced fibrosis at 10 kPa.
During a median follow-up of 34.5 months, 7.8% of patients developed liver complications, 7% developed HCC, and 4.9% died. Compared to values before treatment, the researchers observed a decrease in hepatic stiffness (16.39 ± 13.37 kPa versus 11.35 ± 9.8 kPa), APRI (1.69 ± 1.94 versus 0.6 ± 0.53) and FIB-4 score (3.92 ± 5.01 versus 2.59 ± 3.17) following SVR. While a transient elastography score greater than 20 kPa independently predicted the development of composite findings (adjusted HR = 3.92; 95% CI, 1.15-13.36), hepatic stiffness before treatment did not was significantly associated with any of the outcomes studied.
“Post-treatment hepatic stiffness was more reliable than pre-treatment values in predicting adverse effects in hepatitis C-infected patients with SVR after DAA treatment,” Anancheunsook concluded.