Prognostic implications of recompensation of decompensated cirrhosis after SVR in patients with hepatitis C

Abstract

Backgound & aims: The Baveno VII consensus introduced the term "recompensated cirrhosis," though few studies have examined its clinical relevance. We analyzed the rate and predictors of recompensation after sustained virological response (SVR) in patients with HCV and evaluated its impact on mortality and hepatocellular carcinoma (HCC) compared to compensated and decompensated cirrhosis.

Methods: We performed a multicenter observational study enrolling 916 patients with HCV-related cirrhosis with a minimum follow-up period of 12 months after SVR. Patients were categorized into three mutually exclusive groups: compensated, decompensated, and recompensated. Patients were followed until the occurrence of liver transplantation, death, or the last follow-up date, whichever came first.

Results: During the study (4.5 ± 2.5 years), 12% (110/916) experienced a decompensating event, 7.7% (71/916) were diagnosed with HCC, and 14.9% (137/916) died. Among the 23% (216/916) of patients who were decompensated at baseline, 63.4% (137/216) achieved recompensation at 12 months. Child-Pugh score (odds ratio 0.69; 95% CI 0.53-0.89; p = 0.005) and the number of past decompensating events were associated with recompensation. The compensated cohort exhibited a lower mortality rate (4.2% [28/663]) than recompensated (36.5% [50/137]) and decompensated (50% [30/60]) patients (p = 0.0001). Along with age (cause-specific hazard ratio [CSHR] 1.03; 95% CI 1.01-1.05; p = 0.0009), albumin (CSHR 0.67; 95% CI 0.45-0.98; p = 0.038), international normalized ratio (CSHR 1.88; 95% CI 1.14-3.10; p = 0.014), and bilirubin levels (CSHR 1.28; 95% CI 1.08-1.50; p = 0.003), recompensated (CSHR 0.30; 95% CI 0.19-0.49; p = 0.0001) and compensated (CSHR 0.09; 95% CI 0.05-0.16; p = 0.0001) states were associated with mortality. By contrast, HCC occurrence was significantly lower in compensated (4.4% [29/662]) than recompensated (14.4% [19/132]) and decompensated (12.1% [7/58]) patients (p = 0.0001).

Conclusions: Two-thirds of patients with decompensated cirrhosis achieved recompensation 12 months after SVR. Survival was better in recompensated patients than in decompensated patients, but still worse than in compensated patients. However, HCC risk remained unchanged in the recompensated cohort.

Impact and implications: The Baveno VII consensus introduced the term "recompensated cirrhosis," though few studies have examined its clinical relevance in hepatitis C. Two out of every three patients with decompensated cirrhosis achieved recompensation 12 months after sustained virological response. Recompensated patients had a better survival rate than those who did not experience clinical resolution of decompensation, although their survival remained lower than that of compensated patients. Hepatocellular screening should be maintained, as its risk did not decrease in the recompensated cohort.

Keywords: Baveno; Hepatitis C; cirrhosis; decompensating event; recompensation.