Prognostic value of liver stiffness in advanced chronic liver disease after Hepatitis C Virus eradication

Background & aim: Sustained-virological-response (SVR) after direct-acting-antiviral (DAA) therapy improves outcomes in patients with HCV-related compensated-advanced-chronic-liver-disease (cACLD). However, it remains unclear whether absolute post-SVR LSM or LSM reduction better predicts prognosis after SVR. This study evaluated the prognostic performance of absolute-values-LSM versus dynamic-change for predicting liver-related-events after SVR. Methods: We retrospectively analysed patients with HCV-related cACLD treated with DAA between December 2014 and March 2022. Baseline and post-SVR non-invasive tests (LSM, FIB-4 and APRI) were assessed. Predictive performance for liver-related events was evaluated using time-dependent receiver operating characteristic analysis. Associations between Baveno-VII criteria for clinically significant LSM improvement and clinical outcomes were assessed using Fine-Grey competing-risk models. Results: During a median of 60 months (95%; CI 52-69), 11/135 patients (8%) developed liver-related events. Patients who developed events had higher baseline LSM than those who remained event-free (24 vs. 18 kPa, p = 0.049), and higher follow-up LSM values (20 vs. 12 kPa, p = 0.043). Follow-up LSM showed good discriminative ability for liver-related events within the first 3 years after SVR (tAUC at 2 years: 0.86 [95% CI 0.75-0.97]; tAUC at 3 years: 0.82 [0.71-0.93]). Follow-up LSM was significantly superior to ΔLSM and percentage ΔLSM at both 2 and 3 years (all p ≤ 0.028). In competing-risk analysis, only follow-up LSM > 20 kPa was significantly associated with liver-related events (subdistribution hazard ratio 5.61, p = 0.007), whereas Baveno-VII criteria for LSM regression were not (SHR 0.33, p = 0.097). Conclusions: Absolute post-treatment-LSM provides stronger prognostic information than dynamic changes from baseline. These findings support repeated post-SVR LSM assessment for risk stratification suggesting the relevance of residual liver disease in predicting liver-related outcomes.