Post-HCV treatment liver stiffness linked with adverse outcomes

Higher fibroscan liver stiffness after hepatitis C antiviral treatment was associated with the development of decompensated cirrhosis, according to study results.

“There are many routinely available clinical and laboratory predictors of the development of liver-related complications after anti-viral treatment, including age, a clinical diagnosis of cirrhosis, fibrosis-4 score, model for end-stage liver disease score and viral clearance by sustained virological response,” George N. Iaonnou, MD, MS, of Veterans Affairs Puget Sound Healthcare System, and colleagues wrote. “It is unclear if liver stiffness before or after treatment is independently associated with adverse liver outcomes even after adjustment for these predictors.”

Researchers analyzed data collected from United States veterans who initiated HCV treatment and had at least one liver stiffness before (n = 492) or after (n = 877) therapy. They assessed whether that liver stiffness impacted development of decompensated cirrhosis, hepatocellular carcinoma or death after adjusting for several factors, including history of cirrhosis, BMI and MELD score.

In the group that experienced post-treatment liver stiffness, 21 patients developed decompensated cirrhosis (2.4%), 26 developed HCC (3%) and 57 died or underwent liver transplantation (6.5%). Patients with post-treatment liver stiffness greater than 20 kilopascals had higher rates of developing decompensated cirrhosis (adjusted HR = 3.85; 95% CI, 1.29-11.5) compared with patients with liver stiffness no greater than 12.5 kPa. They also had higher rates of composite outcome of death, liver transplantation, decompensated cirrhosis or HCC (aHR = 1.95; 95% CI, 1.07-3.56).

Researchers found no associations between pre-treatment liver stiffness and any adverse outcome.

“In patients with HCV treated with anti-viral therapies, obtaining a post-treatment liver stiffness measurement may be beneficial in identifying patients at risk for long-term adverse outcomes,” Iaonnou and colleagues wrote.