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Risk Factors for Liver Decompensation and HCC in HCV-Cirrhotic Patients after DAAs: A Multicenter Prospective Study

Filomena Morisco1, Alessandro Federico2, Massimo Marignani3

  • 1Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.

Cancers
|August 7, 2021
PubMed

Insights

Cirrhotic patients achieving sustained virologic response (SVR) after direct-acting antiviral (DAA) therapy face liver-related events. Baseline liver stiffness (LSM) ≥ 20 kPa predicts higher risk in these Hepatitis C Virus (HCV) patients.

Area of Science:

  • Hepatology
  • Virology
  • Gastroenterology

Background:

  • Limited prospective data exists on predicting liver-related events in cirrhotic patients achieving sustained virologic response (SVR) post-direct-acting antiviral (DAA) therapy.
  • Hepatitis C Virus (HCV) infection can lead to cirrhosis and significant liver-related complications.

Purpose of the Study:

  • To identify predictors of liver-related events in cirrhotic patients with SVR after DAAs.
  • To assess the risk of hepatocellular carcinoma (HCC), liver decompensation, and hepatic death.

Main Methods:

  • Prospective enrollment of 706 HCV cirrhotic patients across four Italian centers (2015-2017).
  • Comparison of SVR (n=687) and no-SVR (n=19) groups regarding liver-related events over 24-month follow-up.
  • Cox regression analysis to determine independent predictors of liver-related events.

Main Results:

  • SVR was achieved in 97.3% of patients.
  • Liver-related events occurred in 8.9% of the SVR group versus 26.3% in the no-SVR group (p < 0.03).
  • Baseline liver stiffness (LSM) ≥ 20 kPa and non-genotype 1 were independent predictors of liver decompensation; LSM > 20 kPa predicted HCC. A decrease in LSM did not reduce event risk.

Conclusions:

  • Baseline LSM ≥ 20 kPa is a significant predictor of increased risk for liver-related events post-SVR in HCV cirrhotic patients.
  • Hepatocellular carcinoma (HCC) and liver decompensation remain risks even after successful SVR.
  • Non-genotype 1 and elevated baseline LSM are key factors for monitoring and management.
Abstract

Keywords:
DAAsHCCHCVcirrhosisliver decompensationliver stiffness

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