Post-treatment LSM rather than change during treatment predicts decompensation in patients with cACLD after HCV cure
Copyright © 2024. Published by Elsevier B.V..
BACKGROUND & AIMS: Baveno VII has defined a clinically significant (i.e., prognostically meaningful) liver stiffness measurement (LSM)-decrease in cACLD by ≥20% associated with a final LSM<20 kPa, or any decrease to <10 kPa. However, these rules have not yet been validated against direct clinical endpoints.
METHODS: We retrospectively analysed cACLD patients (LSM≥10 kPa) with paired liver stiffness measurement (LSM) before (BL) and after (FU) HCV-cure by interferon-free therapies from 15 European centers. The cumulative incidence of hepatic decompensation was compared according to these criteria, considering hepatocellular carcinoma and non-liver-related death as competing risks.
RESULTS: 2335 patients followed for a median of 6 years were analysed. Median BL-LSM was 16.6 kPa with 37.1% having ≥20 kPa. After HCV-cure, FU-LSM decreased to a median of 10.9 kPa (<10 kPa: 1002 [42.9%], ≥20 kPa: 465 [19.9%]) translating into a median LSM-change of -5.3 (-8.8-[-2.4])kPa corresponding to -33.9 (-48.0-[-15.9])%. Patients achieving a clinically significant decrease (65.4%) had a significantly lower risk of hepatic decompensation (subdistribution hazard ratio [SHR]: 0.12 [95%CI: 0.04-0.35], p<0.001). However, these risk differences were primarily driven by a negligible risk in patients with FU-LSM <10 kPa (5y-cumulative incidence: 0.3%) compared to a high risk in patients with FU-LSM ≥20 kPa (16.6%). Patients with FU-LSM 10-19.9 kPa (37.4%) also had a low risk of hepatic decompensation (5y-cumulative incidence: 1.7%), and importantly, the risk of hepatic decompensation did not differ between those with/without an LSM-decrease ≥20% (p=0.550).
CONCLUSIONS: FU-LSM is key for risk stratification after HCV-cure and should guide clinical decision-making. LSM dynamics do not hold significant prognostic information in patients with FU-LSM 10-19.9 kPa, and thus, their consideration is not of sufficient incremental value in the specific context of HCV-cure.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of hepatology - (2024) vom: 21. März |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Chronic hepatitis C |
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| Anmerkungen: |
Date Revised 23.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.jhep.2024.03.015 |
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| 100 | 1 | |a Semmler, Georg |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Post-treatment LSM rather than change during treatment predicts decompensation in patients with cACLD after HCV cure |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 23.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024. Published by Elsevier B.V. | ||
| 520 | |a BACKGROUND & AIMS: Baveno VII has defined a clinically significant (i.e., prognostically meaningful) liver stiffness measurement (LSM)-decrease in cACLD by ≥20% associated with a final LSM<20 kPa, or any decrease to <10 kPa. However, these rules have not yet been validated against direct clinical endpoints | ||
| 520 | |a METHODS: We retrospectively analysed cACLD patients (LSM≥10 kPa) with paired liver stiffness measurement (LSM) before (BL) and after (FU) HCV-cure by interferon-free therapies from 15 European centers. The cumulative incidence of hepatic decompensation was compared according to these criteria, considering hepatocellular carcinoma and non-liver-related death as competing risks | ||
| 520 | |a RESULTS: 2335 patients followed for a median of 6 years were analysed. Median BL-LSM was 16.6 kPa with 37.1% having ≥20 kPa. After HCV-cure, FU-LSM decreased to a median of 10.9 kPa (<10 kPa: 1002 [42.9%], ≥20 kPa: 465 [19.9%]) translating into a median LSM-change of -5.3 (-8.8-[-2.4])kPa corresponding to -33.9 (-48.0-[-15.9])%. Patients achieving a clinically significant decrease (65.4%) had a significantly lower risk of hepatic decompensation (subdistribution hazard ratio [SHR]: 0.12 [95%CI: 0.04-0.35], p<0.001). However, these risk differences were primarily driven by a negligible risk in patients with FU-LSM <10 kPa (5y-cumulative incidence: 0.3%) compared to a high risk in patients with FU-LSM ≥20 kPa (16.6%). Patients with FU-LSM 10-19.9 kPa (37.4%) also had a low risk of hepatic decompensation (5y-cumulative incidence: 1.7%), and importantly, the risk of hepatic decompensation did not differ between those with/without an LSM-decrease ≥20% (p=0.550) | ||
| 520 | |a CONCLUSIONS: FU-LSM is key for risk stratification after HCV-cure and should guide clinical decision-making. LSM dynamics do not hold significant prognostic information in patients with FU-LSM 10-19.9 kPa, and thus, their consideration is not of sufficient incremental value in the specific context of HCV-cure | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Chronic hepatitis C | |
| 650 | 4 | |a Compensated advanced chronic liver disease | |
| 650 | 4 | |a Etiological cure | |
| 650 | 4 | |a Liver stiffness measurement | |
| 650 | 4 | |a SVR | |
| 650 | 4 | |a Sustained virological response | |
| 650 | 4 | |a Transient elastography | |
| 700 | 1 | |a Alonso López, Sonia |e verfasserin |4 aut | |
| 700 | 1 | |a Pons, Monica |e verfasserin |4 aut | |
| 700 | 1 | |a Lens, Sabela |e verfasserin |4 aut | |
| 700 | 1 | |a Dajti, Elton |e verfasserin |4 aut | |
| 700 | 1 | |a Griemsmann, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Zanetto, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Burghart, Lukas |e verfasserin |4 aut | |
| 700 | 1 | |a Hametner-Schreil, Stefanie |e verfasserin |4 aut | |
| 700 | 1 | |a Hartl, Lukas |e verfasserin |4 aut | |
| 700 | 1 | |a Manzano, Marisa |e verfasserin |4 aut | |
| 700 | 1 | |a Rodriguez-Tajes, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Zanaga, Paola |e verfasserin |4 aut | |
| 700 | 1 | |a Schwarz, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Luisa Gutierrez, María |e verfasserin |4 aut | |
| 700 | 1 | |a Jachs, Mathias |e verfasserin |4 aut | |
| 700 | 1 | |a Pocurull, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Polo, Benjamín |e verfasserin |4 aut | |
| 700 | 1 | |a Ecker, Dominik |e verfasserin |4 aut | |
| 700 | 1 | |a Mateos, Beatriz |e verfasserin |4 aut | |
| 700 | 1 | |a Izquierdo, Sonia |e verfasserin |4 aut | |
| 700 | 1 | |a Real, Yolanda |e verfasserin |4 aut | |
| 700 | 1 | |a Ahumada, Adriana |e verfasserin |4 aut | |
| 700 | 1 | |a Josef Maria Bauer, David |e verfasserin |4 aut | |
| 700 | 1 | |a Benjamin Mauz, Jim |e verfasserin |4 aut | |
| 700 | 1 | |a Casanova-Cabral, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Gschwantler, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Paolo Russo, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Azzaroli, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Maasoumy, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Reiberger, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Forns, Xavier |e verfasserin |4 aut | |
| 700 | 1 | |a Genesca, Joan |e verfasserin |4 aut | |
| 700 | 1 | |a Bañares, Rafael |e verfasserin |4 aut | |
| 700 | 1 | |a Mandorfer, Mattias |e verfasserin |4 aut | |
| 700 | 0 | |a cACLD-SVR Study Group (in alphabetical order) |e verfasserin |4 aut | |
| 700 | 1 | |a Maria Agostini, Sofia |e investigator |4 oth | |
| 700 | 1 | |a Balcar, Lorenz |e investigator |4 oth | |
| 700 | 1 | |a Battistella, Sara |e investigator |4 oth | |
| 700 | 1 | |a Chromy, David |e investigator |4 oth | |
| 700 | 1 | |a Cornberg, Markus |e investigator |4 oth | |
| 700 | 1 | |a Deterding, Katja |e investigator |4 oth | |
| 700 | 1 | |a Fernandez, Inmaculada |e investigator |4 oth | |
| 700 | 1 | |a Fernandez-Rodriguez, Conrado |e investigator |4 oth | |
| 700 | 1 | |a Gea, Francisco |e investigator |4 oth | |
| 700 | 1 | |a Koeck, Fiona |e investigator |4 oth | |
| 700 | 1 | |a Krawanja, Julia |e investigator |4 oth | |
| 700 | 1 | |a Neumayer, Daniela |e investigator |4 oth | |
| 700 | 1 | |a Riado, Daniel |e investigator |4 oth | |
| 700 | 1 | |a Diego, Rincón |e investigator |4 oth | |
| 700 | 1 | |a Schwabl, Philipp |e investigator |4 oth | |
| 700 | 1 | |a Simbrunner, Benedikt |e investigator |4 oth | |
| 700 | 1 | |a Trauner, Michael |e investigator |4 oth | |
| 700 | 1 | |a Uson, Clara |e investigator |4 oth | |
| 700 | 1 | |a Wedemeyer, Heiner |e investigator |4 oth | |
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