Metabolic dysfunction outperforms ultrasonographic steatosis to stratify hepatocellular carcinoma risk in patients with advanced hepatitis C cured with direct-acting antivirals |
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| Authors: | Serena Pelusi Cristiana Bianco Massimo Colombo Giuliana Cologni Paolo del Poggio Nicola Pugliese Daniele Prati Marie Graciella Pigozzi Roberta D'Ambrosio Pietro Lampertico Stefano Fagiuoli Luca Valenti for the NAVIGATORE-Lombardia Network |
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| Affiliation: | 1. Department of Transfusion Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;2. Liver Center, San Raffaele Hospital, Milan, Italy;3. Department of Internal Medicine, Papa Giovanni Hospital, Bergamo, Italy;4. Department of Gastroenterology and Hepatology, Papa Giovanni Hospital, Zingonia, Italy;5. Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy;6. Department of Gastroenterology, Spedali Civili Hospital, Brescia, Italy;7. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology, Milan, Italy;8. Gastroenterology, Hepatology and Transplantation Unit, Department of Specialty and Transplant Medicine, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy |
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| Abstract: | Background and Aims Metabolic dysfunction (MD)-associated fatty liver disease has been proposed to identify individuals at risk of liver events irrespectively of the contemporary presence of other liver diseases. The aim of this study was to examine the impact of MD in patients cured of chronic hepatis C (CHC). Patients and Methods We analysed data from a real-life cohort of 2611 Italian patients cured of CHC with direct antiviral agents and advanced liver fibrosis, without HBV/HIV, transplantation and negative for hepatocellular carcinoma (HCC) history (age 61.4 ± 11.8 years, 63.9% males, median follow-up 34, 24–40 months). Information about ultrasonographic steatosis (US) after sustained virological response was available in 1978. Results MD affected 58% of patients, diagnosed due to the presence of diabetes (MD-diabetes, 19%), overweight without diabetes (MD-overweight, 37%) or multiple metabolic abnormalities without overweight and diabetes (MD-metabolic, 2%). MD was more frequent than and not coincident with US (32% MD-only, 23% MD-US and 13% US-only). MD was associated with higher liver stiffness (p < 0.05), particularly in patients with MD-diabetes and MD-only subgroups, comprising older individuals with more advanced metabolic and liver disease (p < 0.05). At Cox proportional hazard multivariable analysis, MD was associated with increased risk of HCC (HR 1.97, 95% CI 1.27–3.04; p = 0.0023). Further classification according to diagnostic criteria improved risk stratification (p < 0.0001), with the highest risk observed in patients with MD-diabetes. Patients with MD-only appeared at highest risk since the sustained virological response achievement (p = 0.008), with a later catch-up of those with combined MD-US, whereas US-only was not associated with HCC. Conclusions MD is more prevalent than US in patients cured of CHC with advanced fibrosis and identifies more accurately individuals at risk of developing HCC. |
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| Keywords: | diabetes HCV hepatocellular carcinoma MAFLD NAFLD |
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