Impact of sustained virologic response in regression of portal hypertension in Egyptian patients with hepatitis C virus-associated cirrhosis and portal hypertension

Abstract

Background Portal hypertension (PH) is a common consequence in hepatitis C virus cirrhotic patients. With interferon alpha-based therapy, SVR was linked to improved PH and fibrosis regression. SVR to oral antiviral regimens is linked to reduced portal pressure in patients with clinically significant portal hypertension (CSPH) at baseline. However, CSPH continues in most of the patients. This study aims to assess the reversibility and/or improvement of PH in Egyptian patients with HCV-related cirrhosis and CSPH after achieving SVR with DAAs. The second aim is to evaluate performance of the noninvasive markers of fibrosis in prediction of the presence and/or reversibility of the CSPH in correlation to radiological and endoscopic parameters. Subjects and methods We evaluated noninvasive parameters, radiological and endoscopic signs of PH at baseline, and/or SVR 24 and SVR 48 post-DAA therapy in 40 patients with cirrhosis and CSPH (group A) and another 40 patients with cirrhosis only (group B). Results In group A, the spleen diameter decreased from baseline (15.74 ± 1.53 cm), and SVR 24 (15.48 ± 1.51), to SVR 48 (15.35 ± 1.49 cm). No ascites detected at SVR 48 in 62.5%. Portal vein diameter and portal vein blood velocity reduced to 13.53 ± 1.07 mm and 14.14 ± 2.2 cm/s at SVR 48, with reversibility of hepatic vein waveform towards the triphasic pattern. Medium to large esophageal varices regressed from 52.5% to 2.5%, and up to 70% of patients showed no EVs at SVR 48. In group A, 24 patients showed complete reversibility of CSPH, and 16 patients showed improvement of CSPH. Child-Pugh score, FIB-4 index, King’s score, and Lok index revealed higher significance for detection of the presence of PH. Child-Pugh score, PC/SD ratio, and Lok index revealed higher significance for detection of reversibility of PH. Conclusion We concluded that CSPH improved after SVR with DAAs and completely regressed in some patients. Upon predicting the presence of PH, Child-Pugh score, FIB-4 index, King’s score, and Lok index were the most significant noninvasive scores. While for predicting the reversibility of PH, Child-Pugh score, PC/SD ratio, and Lok index were the most significant scores.

Platelet Count/Spleen Diameter Ratio as a Non-invasive Parameter in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis

“…In the current study, total bilirubin was found to be higher in patients with varices than in patients without varices with statistical significance. This came in agreement with [32] who documented that a high total bilirubin level was found with varices presence. On the other hand, [33] showed no association between bilirubin level with esophageal varices.…”

“…As shown in Table 2 the findings of the studied groups revealed that there was significantly higher (P-< 0.000) mean values of spleen diameter, portal vein diameter, and ascites between both groups A and B. This came in agreement with the study of Faheem et al [32] who found that portal vein diameter and spleen diameter which are indirect predictors of portal hemodynamics can be used effectively as a screening test without subjecting patients to EGD.…”

Pretreatment Predictors Associated with Improvement in Hepatitis C Virus Related Decompensated Cirrhosis after Direct-Acting Antiviral Therapy

“…HCC developed in 2 patients at 12 weeks after EOT (SVR) and 4 patients at 24 weeks after SVR without any significance which was consistent with a large Egyptian study conducted by Shiha et al who found that HCC incidence decreased in HCV-related decompensated patients who achieved SVR [25]. The number of ascetic patients was significantly decreased at 24 weeks after SVR compared to baseline which might be attributed to DAAs' ability to reduce further hepatic decompensation and portal hypertension that reported by many studies [20,22]…”

Predicting de‐novo portal vein thrombosis after HCV eradication: A long‐term competing risk analysis in the ongoing PITER cohort

“…31 Some studies have shown that most patients who achieve the SVR by DAA treatment experienced a significant decrease in the portal pressure 32,33 and an increase in the portal blood flow velocity. 34,35 Since slow portal blood flow is a major risk factor for the development of PVT, 2 this might partly explain the low incidence of PVT in our cohort.…”