Determinants of re-compensation in patients with hepatitis B virus-related decompensated cirrhosis starting antiviral therapy
- Authors
- Kim, Tae Hyung; Um, Soon Ho; Lee, Young-Sun; Yim, Sun Young; Jung, Young Kul; Seo, Yeon Seok; Kim, Ji Hoon; An, Hyunggin; Yim, Hyung Joon; Yeon, Jong Eun; Byun, Kwan Soo
- Issue Date
- 1월-2022
- Publisher
- WILEY
- Citation
- ALIMENTARY PHARMACOLOGY & THERAPEUTICS, v.55, no.1, pp.83 - 96
- Indexed
- SCIE
SCOPUS
- Journal Title
- ALIMENTARY PHARMACOLOGY & THERAPEUTICS
- Volume
- 55
- Number
- 1
- Start Page
- 83
- End Page
- 96
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/135307
- DOI
- 10.1111/apt.16658
- ISSN
- 0269-2813
- Abstract
- Background Despite antiviral therapy, liver function often fails to recover in patients with hepatitis B virus (HBV)-related decompensated cirrhosis. Aim To establish a prognostic model to predict re-compensation in patients starting potent nucleos(t)ide analogue (NUC) therapy Methods We analysed 311 consecutive patients with HBV-related decompensated cirrhosis treated with entecavir or tenofovir. The primary outcome was re-compensation, defined as recovery to a Child-Pugh score of 5. The BC2AID score was developed from a cohort of 152 subjects based on competing risk models and validated in another cohort of 159 subjects. Results Re-compensation occurred in 57.2% and 66.7% of the subjects in the derivation and validation cohorts, respectively. Six independent predictors for re-compensation were identified in the derivation cohort and these comprised the BC2AID score: bilirubin <= 5 mg/dL (adjusted sub-distribution hazard ratio [aSHR] 2.18), absence of severe complications (aSHR 2.78), alpha-fetoprotein (AFP) >= 50 ng/mL (aSHR 2.54), alanine aminotransferase >= 200 IU/L (aSHR 2.62), international normalised ratio <= 1.5 (aSHR 2.37) and <= 6 months from initial decompensation until initiation of NUCs (aSHR 4.79). In the validation cohort, the area under the receiver operating characteristic curve of the BC2AID score for re-compensation within 1 year of NUC therapy was significantly higher than that of the Child-Pugh, MELD, MELDNa and BE3A scores (0.813 vs 0.691, 0.638, 0.645 and 0.624, respectively; all P < 0.05). Conclusions Six clinical parameters, including AFP and the timing of antiviral therapy, were combined into a scoring system to accurately predict early re-compensation in patients with HBV-related decompensated cirrhosis.
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