On-treatment changes of liver stiffness at week 26 could predict 2-year clinical outcomes in HBV-related compensated cirrhosis

Background & Aims It is unclear whether liver stiffness measurement (LSM) dynamic changes after anti-HBV treatment could predict the risk of liver related events (LREs), particularly in patients with HBV-related compensated cirrhosis. Methods Treatment-naive patients with HBV-related compensated cirrhosis were enrolled. All patients were under entecavir-based anti-viral therapy, and followed up every 26 weeks for two years. The association between LSM and LREs were analyzed by Cox proportional hazard model and Harrell C-index analysis. Results A total of 438 patients were included in the study. At the follow-up of 104 weeks, LREs developed in 33/438(7.8%) patients, including 16 episodes of decompensation, 18 HCC and 3 deaths. The median LSM remained high from 20.9, 18.6, 20.4 to 20.3 Kpa at week 0, 26, 52 and 78 among patients with LREs, whereas the LSM decreased from 17.8, 12.3, 10.6 to 10.2 Kpa in patients without LREs, respectively. Percentage changes of LSM at 26 weeks from baseline was significantly associated with LREs (excluding 11 cases occurred within the first 26 weeks), with a crude hazard ratio of 2.94(95% CI: 1.73-5.00) and an albumin-adjusted hazard ratio of 2.47(95% CI: 1.49-4.11). The Harrell C-index of these two models for predicting 2-year LREs were 0.68(95% CI: 0.56-0.80) and 0.75(95% CI: 0.65-0.85), respectively. Nomograms were developed to identify individuals at high risk for point-of-care application. Conclusions Dynamic changes of LSM alone, or combined with baseline albumin, could predict LREs in patients with HBV-related compensated cirrhosis during anti-viral therapy. This article is protected by copyright. All rights reserved.