Liver and Bile
Dig Liver Dis. 2023;55(11):1472–9
Dynamics of liver stiffness predicts complications in patients with HCV-related cirrhosis treated with direct-acting antivirals
Background: Direct-acting antivirals (DAAs) are effective in reducing inflammatory and fibrotic markers in patients with chronic hepatitis C virus (HCV) infection and to prevent liver-related complications. Two-dimensional shear wave elastography (2D-SWE) is an effective technique for the assessment of liver fibrosis.
Aim: To evaluate changes in liver stiffness (LS) in HCV cirrhotic patients undergoing DAA therapy and to identify non-invasive parameters that predict the occurrence of liver-related events.
Methods: The authors enrolled 229 patients who received DAAs between January 2015 and October 2018. Ultrasound parameters and laboratory data were assessed before treatment and 24 (T1) and 48 (T2) weeks after end of treatment. Patients were followed up every 6 months to evaluate the development of hepatocellular carcinoma (HCC) and other liver-related complications. Multiple Cox regression analysis was used to determine parameters associated with the development of complications.
Results: Model for End-stage Liver Disease (MELD) score (hazard ratio [HR] = 1.16; 95% confidence interval [CI]: 1.01–1.33; p = 0.026) and a change in LS at T2 (1-year Delta LS) < 20% (HR = 2.98; 95% CI: 1.01–8.1; p = 0.03) were independently associated with HCC risk. One-year Delta-LS < 20% was independently associated with the development of ascites (HR = 5.08; 95% CI: 1.03–25.14; p = 0.04).
Conclusions: Dynamic changes of 2-dimensional shear wave elastography-measured liver stiffness after therapy with direct-acting antivirals may be a useful tool to identify patients who are at higher risk of liver-related complications.