Hospital Federal de Bonsucesso, Serviço de Gastroenterologia e Hepatologia, Rio de Janeiro, RJ, Brazil; Universidade Estácio de Sá, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil.
Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2022 Sep-Oct;26(5):102697. doi: 10.1016/j.bjid.2022.102697. Epub 2022 Aug 27.
The outcomes regarding portal hypertension-related complications and infections after HCV cure in decompensated cirrhosis are scarcely reported. We aimed to identify the predictors of survival and to evaluate the frequency of decompensation events of cirrhosis, including hepatocellular carcinoma (HCC), portal hypertension complications and infections in a cohort of decompensated cirrhotic with sustained virological response (SVR) in a real-world scenario.
This was a prospective study in consecutive HCV-infected patients with decompensated cirrhosis who achieved SVR after direct-acting antiviral (DAA) treatment. At baseline, clinical and laboratory data were recorded. Patients were followed until development of outcomes regarding further decompensation, death, or liver transplant. A Cox-regression analysis was performed and survival curves were constructed using the Kaplan Mayer method.
One hundred and thirty patients (age 60 ± 9 years, 64% female, 70% genotype 1) were included and followed-up through three years. SVR was associated with a lower prevalence of ascites and an improvement in Child-Pugh and MELD scores. One and three-year probability of transplant-free survival was 93% and 66%, respectively. Variables related to three-years survival were MELD < 11 (HR 1.24, 95% CI 1.13-1.37) and absence of ascites (HR 2.03, 95% CI 0.99-4.13) after the end of treatment (91% versus 37% in patients with ascites and a higher MELD, p < 0.001).
Decompensated cirrhotics with SVR and a low MELD without ascites have an excellent long-term prognosis. On the contrary, those with higher MELD and ascites have a low probability of survival even in the short term and might be evaluated for liver transplantation.
关于丙型肝炎病毒（HCV）治愈后失代偿期肝硬化患者门静脉高压相关并发症和感染的结局，相关报道甚少。本研究旨在确定生存预测因素，并评估在真实环境下，经直接作用抗病毒药物（DAA）治疗后获得持续病毒学应答（SVR）的失代偿期肝硬化患者中，肝硬化失代偿事件（包括肝细胞癌[HCC]、门静脉高压并发症和感染）的发生率。
这是一项对 HCV 感染且失代偿期肝硬化患者的前瞻性研究，这些患者经 DAA 治疗后获得 SVR。基线时记录临床和实验室数据。对患者进行随访，直至出现进一步失代偿、死亡或肝移植的结局。进行 Cox 回归分析，并使用 Kaplan-Meier 方法构建生存曲线。
共纳入 130 例患者（年龄 60±9 岁，64%为女性，70%为基因型 1），并随访 3 年。SVR 与腹水发生率降低以及 Child-Pugh 和 MELD 评分改善相关。无移植生存 1 年和 3 年的概率分别为 93%和 66%。与 3 年生存相关的变量包括治疗结束时 MELD<11（HR 1.24，95%CI 1.13-1.37）和无腹水（HR 2.03，95%CI 0.99-4.13）（腹水和较高 MELD 的患者 1 年生存率分别为 91%和 37%，p<0.001）。
SVR 且 MELD 低且无腹水的失代偿期肝硬化患者具有极好的长期预后。相反，那些 MELD 较高且有腹水的患者即使在短期内生存的可能性也较低，可能需要评估肝移植。
