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

Filomena Morisco; Alessandro Federico; Massimo Marignani; Mariarita Cannavò; Giuseppina Pontillo; Maria Guarino; Marcello Dallio; Paola Begini; Rosa G Benigno; Flavia L Lombardo; Tommaso Stroffolini

doi:10.3390/cancers13153810

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

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

Affiliations

¹ Gastroenterology and Hepatology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
² Hepato-Gastroenterology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy.
³ Department of Liver Diseases Section, AOU Sant'Andrea Hospital, University of Hospital La Sapienza, 00189 Rome, Italy.
⁴ Liver Unit, Department of Internal Medicine, ARNAS Garibaldi, 95100 Catania, Italy.
⁵ National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, 00161 Rome, Italy.
⁶ Department of Tropical and Infectious Disease, Policlinico Umberto I, 00161 Rome, Italy.

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.