Post-treatment LSM rather than change during treatment predicts decompensation in patients with cACLD after HCV cure

作者：Georg Semmler, Sonia Alonso López, Mònica Pons, Sabela Lens, Elton Dajti, Marie Griemsmann, Alberto Zanetto, Lukas Burghart, Stefanie Hametner‐Schreil, Lukas Hartl, Marisa Manzano, Sergio Rodríguez‐Tajes, Paola Zanaga, Michael Schwarz, María Luisa Gutiérrez García, Mathias Jachs, Anna Pocurull, Benjamín Polo Lorduy, D. Ecker, Beatriz Mateos, Sonia Izquierdo, Yolanda Real, Adriana Ahumada, David Bauer, Jim Benjamin Mauz, Michelle Casanova-Cabral, Michael Gschwantler, Francesco Paolo Russo, Francesco Azzaroli, Benjamin Maasoumy, Thomas Reiberger, Xavier Forns, Joan Genescà, Rafael Bañares, Mattias Mandorfer, S. Agostini, Lorenz Balcar, Sara Battistella, David Chromy, Markus Cornberg, Katja Deterding, Inmaculada Fernández, Conrado Fernández‐Rodríguez, Francisco Gea, Fiona Koeck, Julia Krawanja, Daniela Neumayer, Daniel Riado, Diego Rincón, Philipp Schwabl, Benedikt Simbrunner, Michael Trauner, Clara Uson, Heiner Wedemeyer · 发表于：Journal of Hepatology · 年份：2024 · DOI：10.1016/j.jhep.2024.03.015 · 被引用次数：29 · 研究领域：Liver Disease Diagnosis and Treatment、Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease and Transplantation

BACKGROUND & AIMS: Baveno VII has defined a clinically significant (i.e., prognostically meaningful) decrease in liver stiffness measurement (LSM) in cACLD as a decrease of ≥20% associated with a final LSM <20 kPa or any decrease to <10 kPa. However, these rules have not yet been validated against direct clinical endpoints. METHODS: We retrospectively analysed patients with cACLD (LSM ≥10 kPa) with paired liver stiffness measurement (LSM) before (BL) and after (FU) HCV cure by interferon-free therapies from 15 European centres. The cumulative incidence of hepatic decompensation was compared according to these criteria, considering hepatocellular carcinoma and non-liver-related death as competing risks. RESULTS: A total of 2,335 patients followed for a median of 6 years were analysed. Median BL-LSM was 16.6 kPa with 37.1% having ≥20 kPa. After HCV cure, FU-LSM decreased to a median of 10.9 kPa (<10 kPa: 1,002 [42.9%], ≥20 kPa: 465 [19.9%]) translating into a median LSM change of -5.3 (-8.8 to -2.4) kPa corresponding to -33.9 (-48.0 to -15.9) %. Patients achieving a clinically significant decrease (65.4%) had a significantly lower risk of hepatic decompensation (subdistribution hazard ratio: 0.12, 95% CI 0.04-0.35, p <0.001). However, these risk differences were primarily driven by a negligible risk in patients with FU-LSM <10 kPa (5-year cumulative incidence: 0.3%) compared to a high risk in patients with FU-LSM ≥20 kPa (16.6%). Patients with FU-LSM 10-19.9 kPa (37.4%) also ha...