Identifying Risk Factors for Hepatocellular Carcinoma in Patients With Delta Hepatitis: A Prognostic Study

Given that delta hepatitis is associated with a 2-6 times higher risk for hepatocellular carcinoma (HCC) compared to HBV monoinfection, we aimed to identify the negative prognostic factors for complications associated with HDV infection (particularly HCC) and to validate BEA score as a screening tool for HCC in HDV. Our retrospective single centre study included all consecutive admissions of adult patients with chronic HDV infection in the period 01.01.2021-31.12.2022. The negative prognostic factors identified were higher MELD (p < 0.0001) and higher BEA score on admission (p < 0.0001), older age on HBV diagnosis (p < 0.0001) and advanced fibrosis when PegINF was administered (p = 0.01). Good prognostic factors were: Class A-BEA score (p = 0.001), normal platelet count (p = 0.00001), normal albumin level (p = 0.001) and prior treatment with PegInf (p = 0.01). ROC curve showed 78.5% sensitivity for BEA score > 2, validating it as a potential screening tool for HCC. Hence, for patients with BEA score > 2 imaging screening should be intensified in order to early diagnose HCC and prompt access to curative treatment. Additionally, the negative prognostic factors identified (MELD > 15, advanced fibrosis when treated with PegINF or diagnosis with HBV infection at an older age) should encourage more frequent monitoring for HCC compared to local guidelines recommendations.