Hepatology (Baltimore, Md.) · 2025
Early on-treatment LSM reliably predicts liver-related events in CHB patients with significant fibrosis and cirrhosis.
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Sun Yameng, Chen Shuyan, Xu Xiaoqian, Piao Hongxin, Chen Guofeng, Jiang Wei, Chen Yongpeng, Xu Mingyi, Ding Huiguo, Xie Wen, Xu Xiaoyuan, Ma Hui, Ma Anlin, Meng Tongtong, Zhou Jialing, Wang Bingqiong, Zhang Mengyang, Ou Xiaojuan, Zhao Xinyan, Jia Jidong, Wu Xiaoning, You Hong
Аннотация
BACKGROUND AND AIMS: Evidence comparing longitudinal liver stiffness measurements (LSMs) dynamics to on-treatment LSM for predicting clinical outcomes in patients receiving etiology therapy is limited. This study aimed to assess the prognostic value of on-treatment LSM in patients with chronic hepatitis B (CHB) receiving antiviral therapy.
APPROACH AND RESULTS: This prospective cohort included patients with CHB and significant fibrosis or cirrhosis. Liver-related events (LREs) were defined as hepatic decompensation, liver transplantation, or liver-related death. The association between LREs and baseline, on-treatment, and dynamic changes in LSM was analyzed. A total of 1116 patients with CHB, including 875 (78.4%) diagnosed with cirrhosis, were followed for a median of 7.5 (2.5-9.5) years. On-treatment LSM was the most reliable predictor of 3-year and 5-year outcomes (AUROC: 0.72-0.78) after 1-3 years of antiviral therapy, outperforming baseline LSM (AUROC: 0.59-0.65) and LSM changes (AUROC: 0.42-0.65).Patients with LSM <10 kPa at 1, 2, or 3 years of antiviral therapy have a much lower risk of LREs, with a 5-year cumulative incidence of 2.2%, 2.6%, and 2.7%, respectively. This finding held true in the cirrhosis subgroup, in the validation cohort, and for predicting decompensations alone. Notably, patients with on-treatment LSM <10 kPa showed better restoration of lobular architecture assessed by liver biopsies.
CONCLUSIONS: On-treatment LSM measured 1-3 years after antiviral therapy offers superior predictive accuracy for LREs compared with baseline or LSM changes, with LSM <10 kPa indicating a significantly lower risk, likely due to improved lobular architecture.
APPROACH AND RESULTS: This prospective cohort included patients with CHB and significant fibrosis or cirrhosis. Liver-related events (LREs) were defined as hepatic decompensation, liver transplantation, or liver-related death. The association between LREs and baseline, on-treatment, and dynamic changes in LSM was analyzed. A total of 1116 patients with CHB, including 875 (78.4%) diagnosed with cirrhosis, were followed for a median of 7.5 (2.5-9.5) years. On-treatment LSM was the most reliable predictor of 3-year and 5-year outcomes (AUROC: 0.72-0.78) after 1-3 years of antiviral therapy, outperforming baseline LSM (AUROC: 0.59-0.65) and LSM changes (AUROC: 0.42-0.65).Patients with LSM <10 kPa at 1, 2, or 3 years of antiviral therapy have a much lower risk of LREs, with a 5-year cumulative incidence of 2.2%, 2.6%, and 2.7%, respectively. This finding held true in the cirrhosis subgroup, in the validation cohort, and for predicting decompensations alone. Notably, patients with on-treatment LSM <10 kPa showed better restoration of lobular architecture assessed by liver biopsies.
CONCLUSIONS: On-treatment LSM measured 1-3 years after antiviral therapy offers superior predictive accuracy for LREs compared with baseline or LSM changes, with LSM <10 kPa indicating a significantly lower risk, likely due to improved lobular architecture.