Liver stiffness by non-invasive tests predicts hepatocellular carcinoma and liver-related complications following viral eradication with direct-acting antivirals in chronic hepatitis C: a retrospective cohort study

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BACKGROUND: High sustained virological response (SVR) was achieved after direct-acting antiviral (DAA) treatment in patients with chronic hepatitis C viral (HCV) infection. Nevertheless, the factors predicting hepatocellular carcinoma (HCC) and liver-related complications (LRC) following SVR are required. METHODS: HCV-infected patients who received DAA and achieved SVR at King Chulalongkorn Memorial Hospital, Thailand during 2011 and 2021 were enrolled. Liver stiffness was measured by transient elastography (TE), AST-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) scores, were collected at pre-treatment and within 12 months after SVR. Cox proportional hazard model assessed predictors of HCC and LRC. RESULTS: A total of 355 participants were enrolled. During the median follow-up period of 27 months, 15 (4.2%) and 24 (6.8%) developed HCC and LRC. Baseline TE showed the highest AUROC of 0.82 and predicted HCC with an adjusted hazard ratio (aHR) of 1.03 [95% confidence interval (CI) 1.00-1.09]. Baseline TE ≥ 13 kPa was associated with LRC with aHR of 3.28 (95%CI 1.17-9.19). In a subgroup analysis of 168 patients with post-treatment liver stiffness, the TE, APRI, and FIB-4 after SVR significantly declined. In the multivariate analysis, only TE ≥ 13 kPa after SVR anticipated HCC and LRC with aHR of 7.75 (95%CI 1.62-37.20) and 3.36 (95%CI 1.09-10.38). CONCLUSIONS: Baseline TE independently predicted HCC and LRC in HCV-infected patients with SVR after DAA therapy. In the subgroup analysis, liver fibrosis regression was observed after SVR. Additionally, post-treatment TE might more reliably anticipate adverse outcomes than pre-treatment values.

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