Posttreatment Nonalcoholic Fatty Liver Disease Fibrosis Scores for Predicting Liver-related Complications in Patients With Chronic Hepatitis C Receiving Direct-acting Antiviral Agents

Wei-Fan Hsu; Hsueh-Chou Lai; Po-Heng Chuang; Wen-Pang Su; Sheng-Hung Chen; Hung-Yao Chen; Hung-Wei Wang; Guan-Tarn Huang; Cheng-Yuan Peng

Disclosures

J Viral Hepat. 2022;29(9):785-79. 

In This Article

Abstract and Introduction

Abstract

Patients with chronic hepatitis C (CHC) have a higher prevalence of hepatic steatosis and dyslipidaemia than healthy individuals. We analysed noninvasive fibrosis assessments, especially nonalcoholic fatty liver disease (NAFLD)-related noninvasive fibrosis tests, for predicting liver-related complications and hepatocellular carcinoma (HCC) occurrence in patients with CHC. This retrospective study enrolled 590 consecutive patients with CHC having a sustained virologic response (SVR) to direct-acting antiviral agent (DAA) therapy. The NAFLD fibrosis score (NFS) exhibiting the highest value of area under the receiver operating characteristic curve (AUROC) was selected for comparison with the fibrosis-4 index (FIB-4). Of the 590 patients, 188 had metabolic syndrome. A multivariate Cox regression analysis identified total bilirubin at 3 or 6 months after DAA therapy (PW12), NFS at PW12 (hazard ratio [HR]: 2.125, 95% confidence interval [CI]: 1.058–4.267, p = .034) and alpha-fetoprotein (AFP) at PW12 (HR: 1.071, 95% CI: 1.005–1.142, p = .034) as the independent predictors of liver-related complications in all patients. In patients with metabolic syndrome, NFS and AFP values at PW12 were independent predictors of liver-related complications and HCC occurrence. Time-dependent NFS AUROC values at PW12 for 1-, 2- and 3-year liver-related complications were higher than NFS values at baseline in patients with metabolic syndrome. NFS at baseline or PW12 is a more effective predictor of liver-related complications than FIB-4 values in all patients. NFS at PW12 may be a useful predictor of liver-related complications and HCC development in patients with CHC with an SVR to DAA therapy, especially in those with metabolic syndrome.

Introduction

Chronic hepatitis C (CHC) may lead to cirrhosis, which has several liver-related complications (LRCs), including oesophageal or gastric varices, ascites, hepatic encephalopathy, hepatorenal syndrome and hepatocellular carcinoma (HCC).[1] Direct-acting antiviral agents (DAAs) have become the standard treatment for CHC. Most patients receiving DAA therapy achieve a sustained virologic response (SVR) regardless of age, liver fibrosis and hepatitis C virus (HCV) genotype, with an excellent safety profile.[2,3]

CHC is well known for its extrahepatic manifestations, such as diabetes mellitus (DM).[4] HCV infection has a unique relationship with lipid metabolism, with circulating HCV virions binding to lipoproteins. Moreover, lipids are essential to the HCV life cycle.[5–7] Therefore, patients with CHC have a higher prevalence of hepatic steatosis and dyslipidaemia than healthy individuals and patients with chronic hepatitis B (CHB).[8,9]

Noninvasive assessments of liver fibrosis, such as the fibrosis-4 index (FIB-4) and aspartate aminotransferase (AST)-to-platelet ratio index (APRI), are used to predict HCC[10,11] and LRCs[12] in patients with CHC. The nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) can identify NAFLD patients with advanced fibrosis.[13] Ampuero et al.[14] recently developed the Hepamet Fibrosis Score (HFS) to identify patients with NAFLD having advanced fibrosis. However, the application of NAFLD-related noninvasive tests, such as NFS and HFS, to predict LRCs or HCC occurrence in patients with CHC is limited.

In this retrospective study, we analysed noninvasive fibrosis assessments, especially NAFLD-related noninvasive fibrosis tests, for predicting LRCs and HCC occurrence in patients with CHC with an SVR to DAA therapy.

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