1 Sezione di Gastroenterologia e Epatologia, PROMISE, University of Palermo, Italy.
2 Dipartimento di Medicina Interna, Unità di Gastroenterologia, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, Università di Genova, Genova, Italy.
In patients with HCV-related advanced cirrhosis, the effects of SVR by DAAs on decompensation and liver deaths is less clearcut, since up to 30 % of patients do not improve, and no predictors of outcome have been identified. We used 13 C-aminopyrine breath test (ABT) to assess whether its changes can predict liver-related outcomes after DAA treatment in patients with HCV cirrhosis.
50 consecutive patients with HCV cirrhosis were enrolled. Patients were included if they had Child A cirrhosis at risk for decompensation -defined as Child A6 (N= 22, 44%) or previous decompensation (N=7, 14%)-, or Child to B cirrhosis (N=21, 42%) eligible to DAA-based antiviral therapy. ABT was performed at baseline and 12 weeks after the end of antiviral therapy. Patients received sofosbuvir-based regimens.
ABT was available for all 50 patients at baseline. The 120' cumulative dose was directly associated at regression analysis only with albumin levels(p=0.001). ABT was available at follow-up week 12 for 41 patients(FUW12), all with SVR, and followed for a median of 25.2 months(range 12.2-32.1 months). Lower ? ABT -defined as changes of 120' cumulative dose from FUW12 to baseline- (HR 0.97, 95%C.I.0.94-0.99;p=0.02) and FUW12 hepatic encephalopathy(HR 19.0, 95%C.I.1.16-310.3;p=0.03) were the only independent predictors of liver events/death at multivariate Cox regression analysis. The AUC of ? ABT was good(0.87, 95%C.I.0.75-0.97), with a delta ≥0% well discriminating patients at lower versus patients at higher risk of liver-related events-death (p<0.001).
In patients with advanced HCV cirrhosis who achieve SVR with DAA, ? ABT assists in assessing the residual likelihood of liver-related events and deaths after viral cure.