Dysmetabolism, Diabetes and Clinical Outcomes in Patients Cured of Chronic Hepatitis C: A Real-Life Cohort Study.

Abstract

The aim of this study was to examine the impact of features of dysmetabolism on liver disease severity, evolution, and clinical outcomes in a real-life cohort of patients treated with direct acting antivirals for chronic hepatitis C virus (HCV) infection. To this end, we considered 7,007 patients treated between 2014 and 2018, 65.3% with advanced fibrosis, of whom 97.7% achieved viral eradication (NAVIGATORE-Lombardia registry). In a subset (n = 748), liver stiffness measurement (LSM) was available at baseline and follow-up. Higher body mass index (BMI; odds ratio [OR] 1.06 per kg/m2 , 1.03-1.09) and diabetes (OR 2.01 [1.65-2.46]) were independently associated with advanced fibrosis at baseline, whereas statin use was protective (OR 0.46 [0.35-0.60]; P < 0.0001 for all). The impact of BMI was greater in those without diabetes (P = 0.003). Diabetes was independently associated with less pronounced LSM improvement after viral eradication (P = 0.001) and in patients with advanced fibrosis was an independent predictor of the most frequent clinical events, namely de novo hepatocellular carcinoma (HCC; hazard ratio [HR] 2.09 [1.20-3.63]; P = 0.009) and cardiovascular events (HR 2.73 [1.16-6.43]; P = 0.021). Metformin showed a protective association against HCC (HR 0.32 [0.11-0.96]; P = 0.043), which was confirmed after adjustment for propensity score (P = 0.038). Diabetes diagnosis further refined HCC prediction in patients with compensated advanced chronic liver disease at high baseline risk (P = 0.024). Conclusion: Metabolic comorbidities were associated with advanced liver fibrosis at baseline, whereas statins were protective. In patients with advanced fibrosis, diabetes increased the risk of de novo HCC and of cardiovascular events. Optimization of metabolic comorbidities treatment by a multi-disciplinary management approach may improve cardiovascular and possibly liver-related outcomes.

• Authors: Luca Valenti, Serena Pelusi, Alessio Aghemo, Sara Gritti, Luisa Pasulo, Cristiana Bianco, Claudia Iegri, Giuliana Cologni, Elisabetta Degasperi, Roberta D'Ambrosio, Paolo Del Poggio, Alessandro Soria, Massimo Puoti, Isabella Carderi, Marie Graciella Pigozzi, Canio Carriero, Angiola Spinetti, Valentina Zuccaro, Massimo Memoli, Alessia Giorgini, Mauro Viganò, Maria Grazia Rumi, Tiziana Re, Ombretta Spinelli, Maria Chiara Colombo, Tiziana Quirino, Barbara Menzaghi, Gianpaolo Lorini, Angelo Pan, Antonella D'Arminio Monforte, Elisabetta Buscarini, Aldo Autolitano, Paolo Bonfanti, Natalia Terreni, Gianpiero Aimo, Monia Mendeni, Daniele Prati, Pietro Lampertico, Massimo Colombo, Stefano Fagiuoli, NAVIGATORE-Lombardia Network
• Journal: Hepatology communications (Hepatol Commun) Vol. 6 Issue 4 Pg. 867-877 (04 2022) ISSN: 2471-254X [Electronic] United States
• PMID: 34811949 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.

Chemical References

• Antiviral Agents

Topics

• Antiviral Agents (therapeutic use)
• Carcinoma, Hepatocellular (epidemiology)
• Cardiovascular Diseases (complications)
• Cohort Studies
• Diabetes Mellitus (drug therapy)
• Hepatitis C, Chronic (complications)
• Humans
• Liver Cirrhosis (diagnosis)
• Liver Neoplasms (epidemiology)
• Sustained Virologic Response