Author information

¹Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.

²Departmental Program "Diseases of the Liver and Biliary System", AOU Federico II, 80131 Naples, Italy.

³UNESCO Chair: Environment, Resources, and Sustainable Development, University of Naples "Federico II", 80123 Naples, Italy.

⁴Hepato-Gastroenterology Unit, University of Campania Luigi Vanvitelli, 80138 Naples, Italy.

⁵Department of Digestive and Liver Disease, S. Andrea University Hospital, 00189 Rome, Italy.

⁶Department of Gastroenterology and Hepatology, Regina Apostolorum Hospital, 00041 Rome, Italy.

⁷National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, 00161 Rome, Italy.

⁸Department of Tropical and Infectious Diseases, Policlinico Umberto I, 00161 Rome, Italy.

Abstract

The prediction of liver-related events (LRE) after sustained virological response (SVR) in HCV-advanced chronic liver disease (ACLD) patients is crucial. We aimed to evaluate incidence and risk factors of LRE in HCV-cirrhotic patients after SVR and to assess dynamic changes of liver stiffness in participants without LRE at the end of follow-up. We enrolled 575 consecutive patients with HCV-ACLD treated with DAAs and followed up for 5 years after SVR12. Overall, 98 (17%) patients developed any type of event, and HCC was the most frequent LRE. The incidence rate was 1.6 per 100 person-years (p/y) for both HCC and hepatic decompensation. Baseline LSM ≥ 20 kPa was the only independent predictor of hepatic decompensation, while LSM ≥ 20 kPa and male sex were independent predictors of HCC development. Among the 341 participants without LRE and with paired LSM, any LSM reduction was observed in 314 (92.1%), and half of them showed a decrease of LSM ≥ 20%. Among patients without LRE, 27.3% of participants without ≥20% LSM decrease at 2 years achieved the 5-year goal; in contrast, 31.6% of participants with ≥20% LSM decrease at 2 years lost it at 5 years. These findings provide evidence that baseline LSM is a tool to stratify patients at risk of developing LRE; the dynamic changes of LSM value suggest the need for monitoring this parameter over time.