Durability and on-treatment predictors of recompensation in entecavir-treated patients with hepatitis B and decompensated cirrhosis
You Deng,
Haiyan Kang,
Huiling Xiang,
Yuemin Nan,
Jinhua Hu,
Qinghua Meng,
Hong Zhao,
Qi Wang,
Jilian Fang,
Jie Xu,
Xiaoming Wang,
Calvin Q. Pan,
Hong You,
Xiaoyuan Xu,
Wen Xie,
Jidong Jia
Affiliations
You Deng
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Haiyan Kang
Shijiazhuang Fifth Hospital, Shijiazhuang, China
Huiling Xiang
Tianjin Third Central Hospital, Tianjin, China
Yuemin Nan
The Third Hospital of Hebei Medical University, Hebei, China
Jinhua Hu
The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
Qinghua Meng
Beijing You-an Hospital, Capital Medical University, Beijing, China
Hong Zhao
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Qi Wang
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Jilian Fang
Peking University People’s Hospital, Beijing, China
Jie Xu
Peking University Third Hospital, Beijing, China
Xiaoming Wang
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Calvin Q. Pan
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Hong You
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Xiaoyuan Xu
Peking University First Hospital, Beijing, China; Corresponding authors. Addresses: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China; (J. Jia), or Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, National Medical Center for Infectious Disease, Beijing 100015, China; (W. Xie), or Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China; (X. Xu).
Wen Xie
Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China; Corresponding authors. Addresses: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China; (J. Jia), or Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, National Medical Center for Infectious Disease, Beijing 100015, China; (W. Xie), or Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China; (X. Xu).
Jidong Jia
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Corresponding authors. Addresses: Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China; (J. Jia), or Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, National Medical Center for Infectious Disease, Beijing 100015, China; (W. Xie), or Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China; (X. Xu).
Background & Aims: Hepatic recompensation may be achieved in patients with decompensated cirrhosis due to chronic hepatitis B (CHB) upon effective suppression of viral replication by nucleos(t)ide analogues (NAs). However, the optimal timing and predictors of recompensation and the subsequent clinical course of patients with CHB with vs. without recompensation are not well-defined. Methods: This study was a retrospective extension of a multi-centre prospective cohort, focusing on patients with CHB and decompensated cirrhosis treated with entecavir. We followed patients beyond treatment week 120 until a second decompensation event or June 2023. We identified the optimal timing and predictors of recompensation by week 120, evaluated durability of recompensation in patients fulfilling recompensation criteria by week 120 and examined late recompensation in those who did not fulfil it by week 120. Results: At treatment week 24, serum albumin ≥34 g/L predicted recompensation by week 120. The Brec-PAS model offered good predictive ability for recompensation by week 120. Of the 283 patients who finished 120 weeks of therapy, 175 were followed beyond week 120 (median follow-up: 240 weeks). Among the 106 patients achieving recompensation by week 120, 92 (86.8%) maintained recompensation for another 120 (72-168) weeks. Among the 69 patients without recompensation by week 120, 40.6% attained late recompensation during the subsequent 120 (72-168) weeks. Additionally, hepatocellular carcinoma incidence was lower in the recompensated group (5.0% vs. 16.13%, p = 0.002). Conclusions: A serum albumin ≥34 g/L at treatment week 24 predicted recompensation by week 120. Recompensation achieved by week 120 of NA treatment is maintained in >80% of patients in the long term. Some patients may achieve recompensation only after >120 weeks of NA treatment. The incidence of hepatocellular carcinoma was reduced but not completely abolished after recompensation. Impact and implications: Our research provides a meaningful contribution to understanding the long-term prognosis of recompensation in patients with chronic hepatitis B and decompensated cirrhosis, as well as to evaluating the predictive value of serum albumin levels, offering a comprehensive view of clinical outcomes after recompensation. The significance of early biomarkers in guiding therapeutic decisions is highlighted, shedding light on the continued benefits and possible risks after recompensation. This enhances the capability for more precise prognostic evaluations and informed therapeutic strategies. For healthcare providers, these insights afford a detailed perspective on patient monitoring and intervention planning, underscoring the need for ongoing assessment past the initial recompensation phase.
