Predictors Associated with Increase in Skeletal Muscle Mass after Sustained Virological Response in Chronic Hepatitis C Treated with Direct Acting Antivirals

Abstract

Aims: We aimed to examine changes in skeletal muscle mass in chronic hepatitis C (CHC) patients undergoing interferon (IFN)-free direct acting antivirals (DAAs) therapy who achieved sustained virological response (SVR).

Patients and methods: A total of 69 CHC patients treated with DAAs were analyzed. We compared the changes in skeletal muscle index (SMI) using bio-impedance analysis at baseline and SMI at SVR. SMI was calculated as the sum of skeletal muscle mass in upper and lower extremities divided by height squared (cm²/m²). Further, we identified pretreatment parameters contributing to the increased SMI at SVR.

Results: SMI in males at baseline ranged from 6.73 to 9.08 cm²/m² (median, 7.65 cm²/m²), while that in females ranged from 4.45 to 7.27 cm²/m² (median, 5.81 cm²/m²). At SVR, 36 patients (52.2%) had increased SMI as compared with baseline. In the univariate analysis, age (p = 0.0392), hyaluronic acid (p = 0.0143), and branched-chain amino acid to tyrosine ratio (BTR) (p = 0.0024) were significant pretreatment factors linked to increased SMI at SVR. In the multivariate analysis, only BTR was an independent predictor linked to the increased SMI at SVR (p = 0.0488).

Conclusion: Pretreatment BTR level can be helpful for predicting increased SMI after SVR in CHC patients undergoing IFN-free DAAs therapy.

Keywords: chronic hepatitis C; direct acting antiviral; skeletal muscle mass; sustained virological response.

Figure 1

Changes in skeletal muscle index (SMI) during interferon (IFN)-free direct acting antivirals (DAAs) therapy at pretreatment and sustained virological response (SVR). (A) For the entire cohort (n = 69); (B) For patients with low muscle mass at baseline (n = 24, as defined by current guidelines [11]); (C) For patients without low muscle mass at baseline (n = 45, as defined by current guidelines [11]).

Figure 2

Changes in SMI according to baseline FIB-4 index. (A) Patients with baseline FIB-4 index ≥2.46 (the median value in our cohort) were defined as the high FIB-4 index group (n = 34). SMI at SVR did not significantly increase as compared with baseline levels (p = 0.9812); (B) Patients with baseline FIB-4 index <2.46 were defined as the low FIB-4 index group (n = 35). SMI at SVR tended to significantly increase as compared with baseline levels (p = 0.0879).

Figure 3

Changes in SMI according to HCV serotype. (A) In the HCV serotype 1 group (n = 55), SMI at SVR did not significantly increase as compared with baseline levels (p = 0.5777); (B) In the HCV serotype 2 group (n = 14), SMI at SVR tended to significantly decrease as compared with baseline levels (p = 0.0708).

Figure 4

Changes in SMI according to HCV viral load. Patients with baseline HCV viral load >6.2 log IU/mL (the median value in our cohort) were defined as the high HCV viral load group (n = 34), while those with baseline HCV viral load ≤6.2 log IU/mL were defined as the low HCV viral load (n = 35). (A) In the high HCV viral load group, SMI at SVR did not significantly increase as compared with baseline levels (p = 0.3797); (B) In the low HCV viral load group, SMI at SVR did not significantly increase as compared with baseline levels (p = 0.1772).

Figure 5

Changes in SMI according age. Patients with the age of >63 years (the median value in our cohort) were defined as the elderly group (n = 34), while those with the age of ≤63 years were defined as the non-elderly group (n = 35). (A) In the elderly group, SMI at SVR did not significantly increase as compared with baseline levels (p = 0.1662); (B) In the non-elderly group, SMI at SVR did not significantly increase as compared with baseline levels (p = 0.5105).