Hepatic Decompensation in Cirrhotic Patients Receiving Antiviral Therapy for Chronic Hepatitis B.

Abstract

OBJECTIVES:

It is unclear if anti-hepatitis B virus (HBV) treatment can eliminate incident hepatic decompensation. Here we report the incidence and predictors of hepatic decompensation among cirrhotic patients receiving antiviral therapy for chronic hepatitis B.

METHODS:

This is a post hoc analysis of two prospective HBV cohorts from Hong Kong and South Korea. Patients with liver stiffness measurement (LSM) ≥10 kPa and compensated liver disease at baseline were included. The primary endpoint was incident hepatic decompensation (jaundice or cirrhotic complications) with competing risk analysis.

RESULTS:

818 patients (mean age, 54.9 years; 519 male [63.4%]) were included in the final analysis. During a mean follow-up of 58.1 months, 32 (3.9%) patients developed hepatic decompensation, among whom 34% were secondary to HCC. Three (0.4%) patients experienced variceal bleeding alone, 27 (3.3%) had non-bleeding decompensation and 13 (1.6%) had more than 2 decompensating events Baseline LSM, diabetes, alanine aminotransferase, platelet, total bilirubin, albumin, prothrombin time, and eGFR were independent predictors of hepatic decompensation. 30/506 (5.9%) patients fulfilling the Baveno VI criteria (LSM ≥20 kPa and/or platelet count <150ⅹ109/L) and 2/312 (0.6%) patients not fulfilling the criteria developed hepatic decompensation (P < .001).

CONCLUSIONS:

Hepatic decompensation is uncommon but not eliminated in patients receiving antiviral therapy for HBV-related cirrhosis, and only a third of decompensating events are secondary to HCC. The Baveno VI criteria, which was originally designed to detect varices needing treatment, can be effectively applied in this population to identify patients at risk of decompensation.

• Authors: Hye Won Lee, Terry Cheuk-Fung Yip, Yee-Kit Tse, Grace Lai-Hung Wong, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Do Young Kim, Henry Lik-Yuen Chan, Sang Hoon Ahn, Vincent Wai-Sun Wong
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 19 Issue 9 Pg. 1950-1958.e7 (09 2021) ISSN: 1542-7714 [Electronic] United States
• PMID: 32889148 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antiviral Agents

Topics

• Antiviral Agents (therapeutic use)
• Carcinoma, Hepatocellular (drug therapy, epidemiology)
• Elasticity Imaging Techniques
• Esophageal and Gastric Varices
• Gastrointestinal Hemorrhage
• Hepatitis B, Chronic (complications, drug therapy)
• Humans
• Liver Cirrhosis (complications, drug therapy)
• Liver Neoplasms (drug therapy)
• Male
• Middle Aged
• Prospective Studies