Posttreatment liver function, but not baseline liver function stratifies patient survival after direct-acting antiviral treatment in decompensated cirrhosis with hepatitis C virus

Abstract

Background: The prognosis of cirrhosis is clearly stratified by liver function. Although direct-acting antiviral (DAA) has recently been used to eliminate hepatitis C virus (HCV), it is not clear whether liver function stratifies the prognosis of decompensated cirrhotic patients treated with DAA.

Methods: A total of 206 HCV-associated decompensated cirrhotic patients who started DAA from February 2019 to December 2021 at 31 Japanese hospitals were prospectively registered.

Results: The median age was 68, and the proportions of patients with Child-Pugh class A (CP-A), CP-B and CP-C were 10% (20/206), 76% (156/206) and 15% (30/206), respectively. Twenty-six patients died, and two patients underwent liver transplantation (LT); the 2- and 3-year LT-free survival rates were 90.0% and 83.2%, respectively. We examined factors associated with LT-free survival using 2 models including either CP class (Model 1) or MELD score (Model 2). In multivariate Cox proportional hazard analysis, CP class at 12 weeks after the end of treatment (EOT) in Model 1 and MELD score at 12 weeks after the EOT in Model 2 were significant factors, while baseline CP class or MELD score was not. Two-year LT-free survival rates were 100%, 91.6% and 60.4% for patients with CP-A, CP-B and CP-C at 12 weeks after the EOT and 95.2% and 69.6% for patients with MELD < 15 and MELD ≥ 15 at 12 weeks after the EOT, respectively.

Conclusions: The prognosis of decompensated cirrhotic patients receiving DAA was stratified by liver function at 12 weeks after the EOT, not by baseline liver function.

Keywords: Child–Pugh score; DAA; Prognosis; Sofosbuvir; Velpatasvir.

Fig. 1

LT-free survival rates among all patients. A LT-free survival rates, B LT-free survival rates according to Child–Pugh class at baseline. Black solid line, patients with Child–Pugh class A; black dotted line, patients with Child–Pugh class B; grey solid line, patients with Child–Pugh class C. The log-rank test and Kaplan–Meier estimation were used to analyze the differences in LT-free survival rates. We compared survival rates according to CP class by the Bonferroni method for multiple comparisons, and unadjusted p-values were shown

Fig. 2

LT-free survival rates excluding nine patients who died or were lost to follow-up by 12 weeks after the EOT. A. LT-free survival rates according to Child–Pugh class at baseline. Black solid line, patients with Child–Pugh class A; black dotted line, patients with Child–Pugh class B; grey solid line, patients with Child–Pugh class C. B. LT-free survival rates according to Child–Pugh class at 12 weeks after the EOT. Black solid line, patients with Child–Pugh class A; black dotted line, patients with Child–Pugh class B; grey solid line, patients with Child–Pugh class C. C LT-free survival rates according to MELD score at baseline. Black line, patients with MELD scores less than 15; grey line, patients with MELD scores of 15 or more. D LT-free survival rates according to MELD score at 12 weeks after the EOT. Black line, patients with MELD scores less than 15; grey line, patients with MELD scores of 15 or more. The log-rank test and Kaplan–Meier estimation were used to analyze the differences in LT-free survival rates. We compared survival rates according to CP class by the Bonferroni method for multiple comparisons, and unadjusted p-values were shown. Abbreviations: EOT end of treatment; MELD score, model for end-stage liver disease score

Fig. 3

Changes in liver function between baseline and 12 weeks after the EOT. A. Child–Pugh class. B. MELD score. Black solid line, improvement; grey solid line, stable; black dotted line, worsening. Abbreviations: EOT end of treatment; MELD score, model for end-stage liver disease score