Liver stiffness‐based score at sustained virologic response predicts liver‐related complications after eradication of hepatitis C virus

Abstract

Abstract To determine whether liver stiffness (LS) and fibrosis‐4 (Fib‐4) index were useful in assessing the occurrence of liver‐related complications (LRC) in chronic hepatitis C (CHC) patients after direct‐acting antivirals (DAAs) had been administered. This retrospective study enrolled CHC patients achieving sustained virological response (SVR) after DAA. A total of 697 (male/female: 294/403, mean age: 63.8 year) patients with measured LS and complete lab data at SVR were enrolled, followed, and analyzed. In a median follow‐up of 21.4 months after SVR, 39 patients developed LRC including 28 with hepatocellular carcinoma (HCC), with the 30‐month cumulative incidence of LRC and HCC being 7.7% and 5.1%, respectively. Predictions of occurrence of LRC and HCC were 0.820 and 0.774 for LS, and 0.775 and 0.737 for Fib‐4, with optimal cutoffs of LS and Fib‐4 being 14.5 kPa and 2.9 for LRC prediction. In multivariate analysis, LS was associated with the occurrence of LRC (hazard ratio: 3.97, 95% confidence interval [1.866, 8.446], p < 0.001) after adjustment for Fib‐4 and diabetes. A risk‐score system combining LS, Fib‐4, and diabetes was developed for LRC risk assessment. Patients were stratified into low‐ (score 0–1), intermediate‐ (score 2–3), and high‐risk (score 4) groups with LRC cumulative incidences of 1.7%, 14.9%, and 36.4%, respectively (p < 0.001). For patients with CHC after DAA, the risk scoring system based on LS, Fib‐4, and diabetes was useful to assess the risk of LRC development during follow‐up; accordingly, it would be advantageous for clinicians to set up more personalized and cost‐effective strategies of surveillance.

Keywords

• chronic hepatitis C
• direct‐acting antivirals
• fibrosis‐4 index
• liver stiffness
• liver‐related complications