Baseline Factors Associated With Improvements in Decompensated Cirrhosis After Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection

Abstract

We identified 5 baseline factors (body mass index, encephalopathy, ascites, and serum levels of alanine aminotransferase and albumin) associated with a reduction of CPT score to class A in patients with hepatitis C virus-associated decompensated cirrhosis receiving DAA therapy. We developed a predictive score using these factors, called the BE3A score, which can be used as a shared decision-making tool, quantifying the potential benefits of DAA therapy for patients with decompensated cirrhosis.

Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

“…In patients with decompensated cirrhosis who are ineligible for liver transplantation, optimal medication management is important to reduce and manage decompensation events and reduce or delay unplanned hospital admissions. Pharmacotherapy for specific disease etiologies, such as chronic hepatitis B or C, may also lead to improvement in liver function and survival . However, medication‐related problems (MRPs), such as nonadherence, mismanagement related to poor patient understanding, and suboptimal monitoring, have been linked with early hospital readmission and substantial resource burden in this group .…”

De Novo Hepatocellular Carcinoma Among Liver Transplant Registrants in the Direct Acting Antiviral Era

“…Although new registrations and transplants for HCV in the United States are declining, there will remain a population of wait‐list registrants with HCV who nonetheless require LT despite having achieved SVR, for complications of liver disease including HCC . Although more data are being generated to guide DAA treatment in patients with decompensated HCV cirrhosis, the need for close surveillance for HCC in patients with advanced liver disease, and particularly those remaining on the LT wait list, may not be overemphasized …”

CON: Patients With Decompensated Cirrhosis Listed for Liver Transplantation Should Be Treated Posttransplant

“…Early attempts to model this were based on the ALLY‐1, SOLAR‐1, and SOLAR‐2 data, so few patients with a MELD score greater than 15 are included, and the changes in the degree of decompensation in patients are not addressed. More recently, El‐Sherif et al published a study of 622 patients with CTP B or C cirrhosis and found that an ALT ≥60 IU/L, albumin greater than 3.5 g/dL, body mass index less than 25, absence of encephalopathy, and absence of ascites each independently predicted regression to CTP A . Each of these factors is given one point, and when added together, it is known as the BE3A (BMI, Encephalopathy, Ascites, Albumin, ALT) score.…”