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. 2021 Jul 29;13(15):3810.
doi: 10.3390/cancers13153810.

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

Filomena Morisco  1 , Alessandro Federico  2 , Massimo Marignani  3 , Mariarita Cannavò  4 , Giuseppina Pontillo  1 , Maria Guarino  1 , Marcello Dallio  2 , Paola Begini  3 , Rosa G Benigno  4 , Flavia L Lombardo  5 , Tommaso Stroffolini  6
Affiliations

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

Filomena Morisco et al. Cancers (Basel). .

Abstract

Background: Prospective studies on predictors of liver-related events in cirrhotic subjects achieving SVR after DAAs are lacking.

Methods: We prospectively enrolled HCV cirrhotic patients in four Italian centers between November 2015 and October 2017. SVR and no-SVR cases were compared according to the presence or absence of liver-related events during a 24-month follow-up. Independent predictors of liver-related events were evaluated by Cox regression analysis.

Results: A total of 706 subjects started DAAs therapy. SVR was confirmed in 687 (97.3%). A total of 61 subjects (8.9%) in the SVR group and 5 (26.3%) in the no-SVR group had liver-related events (p < 0.03). The incidence rate x 100 p/y was 1.6 for HCC, 1.7 for any liver decompensation, and 0.5 for hepatic death. Baseline liver stiffness (LSM) ≥ 20 kPa (HR 4.0; 95% CI 1.1-14.1) and genotype different from 1 (HR 7.5; 95% CI 2.1-27.3) were both independent predictors of liver decompensation. Baseline LSM > 20 KPa (HR 7.2; 95% CI 1.9-26.7) was the sole independent predictor of HCC. A decrease in liver stiffness (Delta LSM) by at least 20% at the end of follow-up was not associated with a decreased risk of liver-related events.

Conclusion: Baseline LSM ≥ 20 kPa identifies HCV cirrhotic subjects at higher risk of liver-related events after SVR.

Keywords: DAAs; HCC; HCV; cirrhosis; liver decompensation; liver stiffness.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence of any event (deaths for hepatic and non-hepatic cause, liver transplantation, liver decompensation, and HCC) in cirrhotic subjects according to SVR (Kaplan–Meier estimates).
Figure 2
Figure 2
Cumulative incidence of liver decompensation (A) and HCC (B) in cirrhotic subjects according to the value of stiffness at baseline (Kaplan–Meier estimates).
Figure 3
Figure 3
Study flowchart with main results.
See this image and copyright information in PMC

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