Early on-treatment change in liver stiffness predicts development of liver-related events in chronic hepatitis B patients receiving antiviral therapy

Authors

  • Beom K. Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
    • Beom Kyung Kim and Hyun Jung Oh have equally contributed to this work.
  • Hyun J. Oh,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    Search for more papers by this author
    • Beom Kyung Kim and Hyun Jung Oh have equally contributed to this work.
  • Jun Y. Park,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Do Y. Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Sang H. Ahn,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    4. Brain Korea 21 Project of Medical Science, Korea
    Search for more papers by this author
  • Kwang H. Han,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    4. Brain Korea 21 Project of Medical Science, Korea
    Search for more papers by this author
  • Yehyun Park,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    Search for more papers by this author
  • Eun J. Yoo,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    Search for more papers by this author
  • Young N. Park,

    1. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    3. Brain Korea 21 Project of Medical Science, Korea
    Search for more papers by this author
  • Seung U. Kim

    Corresponding author
    1. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    • Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    Search for more papers by this author

Correspondence

Seung Up Kim, MD, Department of Internal medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun–gu, Seoul 120–752, Korea

Tel: +82–2–2228–1982

Fax: +82–2–393–6884

e-mail: ksukorea@yuhs.ac

Abstract

Backgrounds/Aims

Monitoring fibrosis is mandatory for detailed prognostification in patients with chronic liver disease. We developed optimized cut-offs for liver stiffness (LS) values, based on the histological subclassification of cirrhosis, and investigated whether early on-treatment changes in LS values can predict long-term prognosis in patients with hepatitis B virus (HBV)-related advanced liver fibrosis receiving antiviral therapy.

Methods

Between 2005 and 2008, 103 patients with F3 or F4 fibrosis on liver biopsy were enrolled prospectively. Cirrhosis was subclassified into three groups (F4A, F4B and F4C) according to Laennec system. The primary end-point was occurrence of liver-related event (LRE), including decompensation, hepatocellular carcinoma and liver-related death.

Results

Suggested LS cut-offs for predicting F4B-FC (vs. F3-F4A) and F4C (vs. F3-F4B) were 11.6 and 18.2 kPa respectively. As proportions of patients with LRE occurrence increased according to histological subclassifications stage F3-4A vs. F4B-4C (7.4% vs. 17.1%) and stage F3-4B vs. F4C (13.8% vs. 18.8%), they also increased according to LS cut-off value of 11.6 kPa (5.9% vs. 23.1%) and 18.2 kPa (9.8% vs. 33.3%) respectively (all P < 0.05). Similarly, according to stratified LS values (<11.6, 11.6–18.2 and ≥18.2 kPa), overall incidence of LREs and each constituent event increased significantly (all P < 0.05). In addition, the observed changes in LS values between baseline and 6 months of follow-up showed significant correlations with LRE development.

Conclusions

Stratified LS values based on Laennec system and dynamic changes in LS values on follow-up may be helpful in assessing risk of LREs in subjects with HBV-related advanced liver fibrosis receiving antiviral therapy.

Ancillary