Liver and Bile
J Hepatol. 2022;76(2):302–10
Incidence of liver- and non-liver-related outcomes in patients with HCV-cirrhosis after SVR
Background and aims: As the long-term benefits of a sustained virological response (SVR) in hepatitis C virus (HCV)-related cirrhosis following direct-acting antiviral (DAA) treatment remain undefined, the authors assessed the incidence and predictors of liver-related events (LREs), non-liver-related events (NLREs) and mortality in DAA-treated patients with cirrhosis.
Methods: Consecutive patients with cirrhosis and SVR were enrolled in a longitudinal, single-center study, and divided into 3 cohorts: Cohort A (Child-Pugh A without a previous LRE), Cohort B (Child-Pugh B or Child-Pugh A with prior non-hepatocellular carcinoma [HCC] LREs), Cohort C (previous HCC).
Results: A total of 636 patients with cirrhosis (median 65 years-old, 58% males, 89% Child-Pugh A) were followed for 51 (8–68) months (Cohort A, n = 480; Cohort B, n = 89; Cohort C, n = 67). The 5-year estimated cumulative incidences of LREs were 10.4% in Cohort A versus 32.0% in Cohort B (HCC, 7.7% vs. 19.7%; ascites, 1.4% vs. 8.6%; variceal bleeding, 1.3% vs. 7.8%; encephalopathy, 0% vs. 2.5%) versus 71% in Cohort C (HCC only) (p < 0.0001). The corresponding figures for NLREs were 11.7% in Cohort A versus 17.9% in Cohort B versus 17.5% in Cohort C (p = 0.32). The 5-year estimated probabilities of liver-related versus non-liver-related deaths were 0.5% versus 4.5% in Cohort A, 16.2% versus 8.8% in Cohort B, and 12.1% versus 7.7% in Cohort C. The all-cause mortality rate in Cohort A was similar to the rate expected for the general population stratified by age, sex and calendar year according to the Human Mortality Database, while it was significantly higher in Cohort B.
Conclusions: Patients with cirrhosis and a sustained virological response on direct-acting antivirals (DAAs) face risks of liver-related and non-liver-related events and mortality; however, their incidence is strongly influenced by pre-DAA patient history.