Liver steatosis is a major predictor of poor outcomes in chronic hepatitis C patients with sustained virological response

Abstract

Sustained virological response (SVR) results in reduced incidence of hepatocellular carcinoma (HCC) and mortality among chronic hepatitis C (CHC) patients with advanced fibrosis. Since both advanced fibrosis and liver steatosis (LS) may coexist in CHC patients, we evaluated their individual effects on a composite outcome of all‐cause mortality and HCC in CHC patients with SVR following direct‐acting antivirals (DAA) treatment. We retrospectively evaluated inception cohort of 515 CHC patients who achieved SVR following treatment with DAA, with a mean follow‐up of 24 months. Baseline liver fibrosis was assessed by transient elastography, and LS was validated by at least three independent ultrasonographic examinations. 211 of 515 patients (41%) had baseline LS. Patients with LS had a higher cumulative rate of all‐cause mortality and HCC at 2 years of follow‐up compared to patients without LS (15.75% and 2.79%, respectively, P < 0.001), although they did not have increased incidence of advanced fibrosis or cirrhosis. Consistently, multivariate analysis showed that LS was associated with a significant 7.5‐fold increased risk of all‐cause mortality and HCC (HR 7.51, 95% C.I 3.61‐13.36, P < 0.001) even upon adjustment to components of the metabolic syndrome, whereas advanced fibrosis showed only a trend towards statistical significance (HR 2.32, 95% C.I 0.97‐6.59, P = 0.06). In conclusion, LS is a major predictor of all‐cause mortality and HCC in patients who achieved SVR following DAA treatment regardless of fibrosis stage. These patients should be rigorously screened for HCC.

Impact of liver‐stiffness measurement on hepatocellular carcinoma development in chronic hepatitis C patients treated with direct‐acting antivirals: A systematic review and time‐to‐event meta‐analysis

“…Direct‐acting antiviral regimens were heterogeneous within and between the studies including ribavirin‐containing and/or sofosbuvir‐based IFN‐free regimens or with pegylated IFN. All patients in five studies achieved 100% SVR, 20,23,24,26,27 while a portion of patients achieved SVR in the other three studies ranged from 94.1% to 97% 21,22,25 …”

“…Seven articles were subsequently excluded after reviewing the full text. Finally, the remaining eight eligible articles were included in this study 20–27 . Among them, Shili et al .…”

“…The characteristics of the eight studies are summarized in Table 1. Four were prospective studies 20,24–26 and four were retrospective observational studies 21–23,27 . The total number of patients in the eight studies was 3507, and the total number of patients without prior HCC history in the eight studies was 3398.…”

“…Reporting was usually insufficient for items related to study design, analysis, and presentation of the guidelines, which emphasized detailed methodology reporting and multivariate analyses results. Regarding the study design items, only three studies clearly defined clinical end‐points in the methods section, 23,24,27 and none of the seven studies provided a rationale for their sample size calculation. All studies performed univariate and multivariate time‐to‐event analyses using the Cox proportional‐hazard regression model, and among them, three studies reported results of further investigations, such as checking assumptions and internal validation 23,24,27 …”

The Patient Bomb: Sustained Viral Response after Hepatitis C in Cirrhosis

“…Finally, SVR is associated with a low risk of, but does not prevent, HCC occurrence or disease progression, especially in the presence of other causes of liver injury. Patients should avoid alcohol [8], lose weight [9], stop smoking, control diabetes [10], and drink coffee.…”