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PROGNOSTIC UTILITY OF THE BAVENO VII CRITERIA FOR A CLINICALLY SIGNIFICANT DECREASE IN LIVER STIFFNESS MEASUREMENT AFTER HCV-CURE

Georg Semmler 1, Sonia Alonso Lopez 2,3,4, Monica Pons 5, Sabela Lens 6,7, Elton Dajti 8, Marie Griemsmann 9, Alberto Zanetto 10, Lukas Burghart 11, Stephanie Hametner-Schreil 12, Lukas Hartl 1, Marisa Manzano 13, Sergio Rodriguez Tajes 6,7, Paola Zanaga 10, Michael Schwarz 1,11, Maria Luisa Gutierrez 14, Mathias Jachs 1, Anna Pocurull Aparicio 6,15, Benjamín Polo Lorduy 16, Dominik Ecker 12, Beatriz Mateos 17, Sonia Izquierdo 18, Yolanda Real 19, Michael Gschwantler 11, Francesco Paolo Russo 10, Francesco Azzaroli 8, Benjamin Maasoumy 9, Thomas Reiberger 1, Xavier Forns 6,15, Joan Genesca 5,20, Rafael Banares 2,3,4, Mattias Mandorfer 1

Affiliations

1 Medical University of Vienna, Vienna, Austria

2 Hospital General Universitario Gregorio Marañón, Madrid, Spain

3 Instituto De Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain

4 Universidad Complutense de Madrid, Madrid, Spain

5 Vall d’Hebron University Hospital, Vall d’Hebron Institut of Research (VHIR), Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain

6 Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain

7 Centro de Investigacíon Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain

8 University of Bologna, Bologna, Italy

9 Hannover Medical School, Hannover, Germany

10 Padua University Hospital, Padua, Italy

11 Klinikum Ottakring, Vienna, Austria

12 Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria

13 Hospital Universitario 12 De Octubre, Madrid, Spain

14 Hospital Universitario Fundación Alcorcón, Madrid, Spain

15 Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain

16 Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain

17 Hospital Universitario Ramón y Cajal, Madrid, Spain

18 Hospital Universitario Clínico San Carlos, Madrid, Spain

19 Hospital Universitario La Princesa, Madrid, Spain

20 Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (C

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Abstract

Introduction

Baveno VII has suggested that a decrease in liver stiffness measurement (LSM) by ≥20% to <20kPa, or any LSM-decrease to a LSM <10kPa is “clinically significant” in compensated advanced chronic liver disease (cACLD). However, these LSM surrogates remain to be validated against direct clinical endpoints for the setting of etiological cure from hepatitis C virus (HCV).

Aims & Methods

We retrospectively analyzed HCV cACLD patients with paired liver stiffness measurement (LSM) before (BL, all LSM≥10kPa) and after (FU) HCV-cure by interferon-free therapies from 15 European centers. The cumulative incidence of hepatic decompensation was compared according to these criteria by competing risk regression analyses, considering hepatocellular carcinoma and non-liver-related death as competing risks.

Results

2314 patients followed for a median of 6 years were analyzed. Median BL-LSM was 16.6kPa with 37% showing BL-LSM ≥20kPa. After HCV-cure, FU-LSM decreased to a median of 11.0kPa (<10kPa: 990 [43%]; ≥20kPa: 462 [20%]) translating into a median LSM-change of -5.3 (-8.7-[-2.3])kPa corresponding to -33.7 (-47.8-[-15.6])%.
Patients meeting criteria for a clinically significant decrease in LSM (<10kPa: n=990 [43%], ≥20% and <20kPa: n=518 [22%]) had a 10-times lower risk of hepatic decompensation (subdistribution hazard ratio [SHR]: 0.10 [95%CI: 0.04-0.30], p<0.001). However, these risk differences were primarily driven by a negligible risk in patients with FU-LSM <10kPa (cumulative incidence at 6 years [6y-CI]: 0.3%; incidence rate [IR] 0.06/100 patient years [py]) compared to a high risk in patients with FU-LSM ≥20kPa (6y-CI: 12.2%; IR: 3.14/100py). Patients with FU-LSM of 10-19.9kPa (37%) also showed a rather low risk of hepatic decompensation (6y-CI:1.8%; IR: 0.30/100py), and importantly, their decompensation risk did not differ between those with/without an LSM-decrease ≥20% (p=0.370).

Conclusion

Dynamics in BL-LSM to FU-LSM provide limited incremental information over a single static FU-LSM for risk stratification after HCV-cure. The latter should guide clinical decision-making.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

Prognosis and prediction in liver disease (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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VALIDATION AND REFINEMENT OF THE BAVENO VII CRITERIA FOR RISK STRATIFICATION IN COMPENSATED ADVANCED CHRONIC LIVER DISEASE AFTER HCV-CURE

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

VALIDATION AND REFINEMENT OF THE BAVENO VII CRITERIA FOR RISK STRATIFICATION IN COMPENSATED ADVANCED CHRONIC LIVER DISEASE AFTER HCV-CURE

Georg Semmler 1, Sonia Alonso Lopez 2,3,4, Monica Pons 5, Sabela Lens 6,7, Elton Dajti 8, Marie Griemsmann 9, Alberto Zanetto 10, Lukas Burghart 1,11, Stephanie Hametner-Schreil 12, Lukas Hartl 1, Marisa Manzano 13, Sergio Rodriguez Tajes 6,14, Paola Zanaga 10, Michael Schwarz 1,11, Maria Luisa Gutierrez 15, Mathias Jachs 1, Anna Pocurull Aparicio 6,14, Benjamín Polo Lorduy 16, Dominik Ecker 12, Beatriz Mateos 17, Sonia Izquierdo 18, Yolanda Real 19, Michael Gschwantler 11, Francesco Paolo Russo 10, Francesco Azzaroli 8, Benjamin Maasoumy 9, Thomas Reiberger 1, Xavier Forns 6,14, Joan Genesca 5,20, Rafael Banares 2,3,4, Mattias Mandorfer 1

Affiliations

1 Medical University of Vienna, Vienna, Austria

2 Hospital General Universitario Gregorio Marañón, Madrid, Spain

3 Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain

4 Universidad Complutense de Madrid, Madrid, Spain

5 Vall d’Hebron University Hospital, Vall d’Hebron Institut of Research (VHIR), Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain

6 Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain

7 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain

8 University of Bologna, Bologna, Italy

9 Hannover Medical School, Hannover, Germany

10 Padua University Hospital, Padua, Italy

11 Klinikum Ottakring, Vienna, Austria

12 Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria

13 Hospital Universitario 12 de Octubre, Madrid, Spain

14 Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain

15 Hospital Universitario Fundación Alcorcón, Madrid, Spain

16 Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain

17 Hospital Universitario Ramón y Cajal, Madrid, Spain

18 Hospital Universitario Clínico San Carlos, Madrid, Spain

19 Hospital Universitario La Princesa, Madrid, Spain

20 Centro de Investigacíon Biomédica en Red de Enfermedades Hepáticas y Digestivas (C