O-6 NON-INVASIVE ASSESSMENT OS HEPATIC FIBROSIS BEFORE AND AFTER HCV CURE AND CORRELATION WITH CLINICAL OUTCOMES

Introduction

Liver stiffness measurement (LSM) is a widely used non-invasive test to assess the stage of liver fibrosis in chronic liver diseases, particularly in HCV but its clinical usefulness after viral elimination is uncertain.

Objectives

To identify the course of liver fibrosis by LSM 3 years after viral elimination in patients with HCV and its association with clinically relevant outcomes: progression to advanced liver fibrosis/cirrhosis (≥F3) in those with F<3 at baseline, and decompensation (ascites, variceal hemorrhage, encephalopathy) or HCC in those with F3/F4 or F4 at baseline.

Methods

LSM were performed by Fibroscan in 228 patients (32 stage F0-1; 47 F2; 36 F3; 23 F3-4; 90 F4 as determined by LS of <7.1; 7.2-9.5; 9.6-12.5; 12.6-14.5 and >14.5 KPa respectively) prior to treatment and at 6 months, 1, 2 and 3 years after cure.

Results

The course of changes in LSM are depicted in figure1. There was no progression to F≥3 in any of the patients at stages F0-1, F2. Among patients with F≥3, 23 patients developed decompensation (1 F3, 2 F3/F4 and 20 F4) and 9 developed HCC (all F4). Probability of decompensation is lower in patients in whom LSM decreases at 6 months, while it is higher in those in whom LSM increases, however CI are large (Table).

Conclusion

While in patients with F0-1, F2 prior to antiviral therapy, there is no need to follow LSM as progression does not occur, LSM should be continued in those with F3/F4 or F4 (>12.5 kPa). Changes in LSM at 6 months can help determine probability of outcomes but larger studies combining other parameters are necessary to improve predictive value.