Hong Chun-Ming, Su Tung-Hung, Hsu Shih-Jer, Tseng Tai-Chung, Liu Chen-Hua, Yang Hung-Chih, Kao Jia-Horng, Chen Pei-Jer, Cheng Pin-Nan, Hung Chao-Hung, Peng Cheng-Yuan, Chen Chien-Hung, Lin Chun-Yen, Kuo Hsing-Tao, Lin Han-Chieh, Huang Yi-Hsiang, Chen Chi-Yi, Lin Chih-Lin, Tsai Pei-Chien, Zeng Yu-Syuan, Dai Chia-Yen, Chuang Wan-Long, Huang Jee-Fu, Huang Chung-Feng, Yeh Ming-Lun, Yu Ming-Lung, Liu Chun-Jen
Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2024 Nov 1. doi: 10.1016/j.jfma.2024.10.024.
Direct-acting antiviral agents (DAAs) achieve high sustained virologic response (SVR) in chronic hepatitis C patients; yet a proportion of patients still experience de novo liver complications after SVR. Identification of risk factors is clinically important. FIB-4 index is a useful noninvasive tool to assess fibrosis, while neutrophil-to-lymphocyte ratio (NLR) is a biomarker for systemic inflammation. Our study aimed to investigate whether the addition of NLR can increase the prediction power of pre-DAA FIB-4 for de novo liver complications after SVR.
We recruited patients via The Taiwan HCV Registry (TACR) and National Health Insurance Registry Database. The inclusion criteria were patients who achieved SVR12 after DAA and were followed for at least 24 months after SVR12. Liver complications included ascites, hepatic encephalopathy, variceal bleeding, and HCC.
Totally 7657 patients were recruited from 2013 to 2018. Among them, 3674 patients (48.0%) had a FIB-4 value > 3.25 and 491 patients (6.4%) had a NLR >4 before DAA. After two-year of follow-up after SVR 12, 214 patients (2.8%) developed de novo liver complications. Factors associated with liver complications included male gender, diabetes mellitus, hyperlipidemia, chronic kidney disease, and pre-DAA FIB-4 >3.25 in multivariate analyses. Addition of NLR slightly did not increase the power of predicting liver complications.
The overall incidence of de novo liver complications after SVR is low during short-term follow-up. Elevated pre-DAA FIB-4 is associated with de novo liver complications after SVR, whereas the addition of pre-DAA NLR does not increase the prediction power.
直接抗病毒药物（DAAs）可使慢性丙型肝炎患者获得较高的持续病毒学应答（SVR）；然而，仍有一部分患者在实现SVR后出现新发肝脏并发症。识别危险因素具有重要的临床意义。FIB-4指数是评估肝纤维化的一种有用的非侵入性工具，而中性粒细胞与淋巴细胞比值（NLR）是全身炎症的生物标志物。我们的研究旨在探讨添加NLR是否能提高DAA治疗前FIB-4对SVR后新发肝脏并发症的预测能力。
我们通过台湾丙型肝炎登记系统（TACR）和国民健康保险登记数据库招募患者。纳入标准为在接受DAA治疗后实现SVR12且在SVR12后至少随访24个月的患者。肝脏并发症包括腹水、肝性脑病、静脉曲张出血和肝癌。
2013年至2018年共招募了7657例患者。其中，3674例患者（48.0%）在接受DAA治疗前FIB-4值>3.25，491例患者（6.4%）在接受DAA治疗前NLR>4。在SVR 12后进行两年随访后，214例患者（2.8%）出现新发肝脏并发症。多因素分析显示，与肝脏并发症相关的因素包括男性、糖尿病、高脂血症、慢性肾脏病以及DAA治疗前FIB-4>3.25。添加NLR略微未增加预测肝脏并发症的能力。
在短期随访期间，SVR后新发肝脏并发症的总体发生率较低。DAA治疗前FIB-4升高与SVR后新发肝脏并发症相关，而添加DAA治疗前NLR并未增加预测能力。
