Metabolic dysfunction outperforms ultrasonographic steatosis to stratify hepatocellular carcinoma risk in patients with advanced hepatitis C cured with direct-acting antivirals
© 2023 The Authors. Liver International published by John Wiley & Sons Ltd..
BACKGROUND AND AIMS: Metabolic dysfunction (MD)-associated fatty liver disease has been proposed to identify individuals at risk of liver events irrespectively of the contemporary presence of other liver diseases. The aim of this study was to examine the impact of MD in patients cured of chronic hepatis C (CHC).
PATIENTS AND METHODS: We analysed data from a real-life cohort of 2611 Italian patients cured of CHC with direct antiviral agents and advanced liver fibrosis, without HBV/HIV, transplantation and negative for hepatocellular carcinoma (HCC) history (age 61.4 ± 11.8 years, 63.9% males, median follow-up 34, 24-40 months). Information about ultrasonographic steatosis (US) after sustained virological response was available in 1978.
RESULTS: MD affected 58% of patients, diagnosed due to the presence of diabetes (MD-diabetes, 19%), overweight without diabetes (MD-overweight, 37%) or multiple metabolic abnormalities without overweight and diabetes (MD-metabolic, 2%). MD was more frequent than and not coincident with US (32% MD-only, 23% MD-US and 13% US-only). MD was associated with higher liver stiffness (p < 0.05), particularly in patients with MD-diabetes and MD-only subgroups, comprising older individuals with more advanced metabolic and liver disease (p < 0.05). At Cox proportional hazard multivariable analysis, MD was associated with increased risk of HCC (HR 1.97, 95% CI 1.27-3.04; p = 0.0023). Further classification according to diagnostic criteria improved risk stratification (p < 0.0001), with the highest risk observed in patients with MD-diabetes. Patients with MD-only appeared at highest risk since the sustained virological response achievement (p = 0.008), with a later catch-up of those with combined MD-US, whereas US-only was not associated with HCC.
CONCLUSIONS: MD is more prevalent than US in patients cured of CHC with advanced fibrosis and identifies more accurately individuals at risk of developing HCC.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:43 |
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| Enthalten in: |
Liver international : official journal of the International Association for the Study of the Liver - 43(2023), 7 vom: 28. Juli, Seite 1593-1603 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pelusi, Serena [VerfasserIn] |
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| Links: |
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| Themen: |
Antiviral Agents |
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| Anmerkungen: |
Date Completed 15.06.2023 Date Revised 18.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/liv.15577 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM355404990 |
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| 100 | 1 | |a Pelusi, Serena |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Metabolic dysfunction outperforms ultrasonographic steatosis to stratify hepatocellular carcinoma risk in patients with advanced hepatitis C cured with direct-acting antivirals |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 15.06.2023 | ||
| 500 | |a Date Revised 18.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. Liver International published by John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND AND AIMS: Metabolic dysfunction (MD)-associated fatty liver disease has been proposed to identify individuals at risk of liver events irrespectively of the contemporary presence of other liver diseases. The aim of this study was to examine the impact of MD in patients cured of chronic hepatis C (CHC) | ||
| 520 | |a PATIENTS AND METHODS: We analysed data from a real-life cohort of 2611 Italian patients cured of CHC with direct antiviral agents and advanced liver fibrosis, without HBV/HIV, transplantation and negative for hepatocellular carcinoma (HCC) history (age 61.4 ± 11.8 years, 63.9% males, median follow-up 34, 24-40 months). Information about ultrasonographic steatosis (US) after sustained virological response was available in 1978 | ||
| 520 | |a RESULTS: MD affected 58% of patients, diagnosed due to the presence of diabetes (MD-diabetes, 19%), overweight without diabetes (MD-overweight, 37%) or multiple metabolic abnormalities without overweight and diabetes (MD-metabolic, 2%). MD was more frequent than and not coincident with US (32% MD-only, 23% MD-US and 13% US-only). MD was associated with higher liver stiffness (p < 0.05), particularly in patients with MD-diabetes and MD-only subgroups, comprising older individuals with more advanced metabolic and liver disease (p < 0.05). At Cox proportional hazard multivariable analysis, MD was associated with increased risk of HCC (HR 1.97, 95% CI 1.27-3.04; p = 0.0023). Further classification according to diagnostic criteria improved risk stratification (p < 0.0001), with the highest risk observed in patients with MD-diabetes. Patients with MD-only appeared at highest risk since the sustained virological response achievement (p = 0.008), with a later catch-up of those with combined MD-US, whereas US-only was not associated with HCC | ||
| 520 | |a CONCLUSIONS: MD is more prevalent than US in patients cured of CHC with advanced fibrosis and identifies more accurately individuals at risk of developing HCC | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a HCV | |
| 650 | 4 | |a MAFLD | |
| 650 | 4 | |a NAFLD | |
| 650 | 4 | |a diabetes | |
| 650 | 4 | |a hepatocellular carcinoma | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 700 | 1 | |a Bianco, Cristiana |e verfasserin |4 aut | |
| 700 | 1 | |a Colombo, Massimo |e verfasserin |4 aut | |
| 700 | 1 | |a Cologni, Giuliana |e verfasserin |4 aut | |
| 700 | 1 | |a Del Poggio, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Pugliese, Nicola |e verfasserin |4 aut | |
| 700 | 1 | |a Prati, Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Pigozzi, Marie Graciella |e verfasserin |4 aut | |
| 700 | 1 | |a D'Ambrosio, Roberta |e verfasserin |4 aut | |
| 700 | 1 | |a Lampertico, Pietro |e verfasserin |4 aut | |
| 700 | 1 | |a Fagiuoli, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Valenti, Luca |e verfasserin |4 aut | |
| 700 | 0 | |a NAVIGATORE-Lombardia Network |e verfasserin |4 aut | |
| 700 | 1 | |a Valenti, Luca |e investigator |4 oth | |
| 700 | 1 | |a Pelusi, Serena |e investigator |4 oth | |
| 700 | 1 | |a Prati, Cristiana Bianco Daniele |e investigator |4 oth | |
| 700 | 1 | |a De Gasperi, Elisabetta |e investigator |4 oth | |
| 700 | 1 | |a D'Ambrosio, Roberta |e investigator |4 oth | |
| 700 | 1 | |a Lampertico, Pietro |e investigator |4 oth | |
| 700 | 1 | |a Aghemo, Alessio |e investigator |4 oth | |
| 700 | 1 | |a Pugliese, Nicola |e investigator |4 oth | |
| 700 | 1 | |a de Nicola, Stella |e investigator |4 oth | |
| 700 | 1 | |a Masetti, Chiara |e investigator |4 oth | |
| 700 | 1 | |a Gritti, Sara |e investigator |4 oth | |
| 700 | 1 | |a Pasulo, Lusia |e investigator |4 oth | |
| 700 | 1 | |a Iegri, Claudia |e investigator |4 oth | |
| 700 | 1 | |a Cologni, Giuliana |e investigator |4 oth | |
| 700 | 1 | |a Viganò, Mauro |e investigator |4 oth | |
| 700 | 1 | |a Fagiuoli, Stefano |e investigator |4 oth | |
| 700 | 1 | |a Del Poggio, Paolo |e investigator |4 oth | |
| 700 | 1 | |a Soria, Alessandro |e investigator |4 oth | |
| 700 | 1 | |a Puoti, Massimo |e investigator |4 oth | |
| 700 | 1 | |a Carderi, Isabella |e investigator |4 oth | |
| 700 | 1 | |a Pigozzi, Marie Graciella |e investigator |4 oth | |
| 700 | 1 | |a Carriero, Canio |e investigator |4 oth | |
| 700 | 1 | |a Spinetti, Angiola |e investigator |4 oth | |
| 700 | 1 | |a Zuccaro, Valentina |e investigator |4 oth | |
| 700 | 1 | |a Memoli, Massimo |e investigator |4 oth | |
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| 700 | 1 | |a Giorgini, Alessia |e investigator |4 oth | |
| 700 | 1 | |a D'Arminio Monforte, Antonella |e investigator |4 oth | |
| 700 | 1 | |a Rumi, Maria Grazia |e investigator |4 oth | |
| 700 | 1 | |a Re, Tiziana |e investigator |4 oth | |
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| 700 | 1 | |a Aimo, Gianpiero |e investigator |4 oth | |
| 700 | 1 | |a Mendeni, Monia |e investigator |4 oth | |
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