Predict improvement of liver cirrhosis after antiviral treatment in patients with chronic hepatitis B
Refereed conference paper presented and published in conference proceedings


摘要Background and aims: Improvement in Model for End-Stage Liver Disease (MELD) score over time under antiviral treatment is associated with reduced hepatic decompensation and death in patients with chronic hepatitis B (CHB)-related cirrhosis. We developed a prediction score for MELD score improvement.

Method: We identified patients with CHB-related cirrhosis and MELD score ≥ 15 at the start of entecavir and/or tenofovir disoproxil fumarate treatment from 2005 to 2016 in Hong Kong and from 2006 to 2017 in Severance Hospital, South Korea. The primary and secondary end points were transplant-free survival with > 5 point improvement in MELD score and with MELD score < 10 after 6 months of treatment, respectively. Patients with cancers up to 6 months of follow-up were excluded. Patients were randomly divided into training (60%) and validation (40%) cohorts. Prediction score was calculated as the weighted sum of selected clinical parameters.

Results: 999 cirrhotic CHB patients were included. During the first 6 months of treatment, 102 (10.2%) patients received liver transplantation and 294 (29.4%) patients died. At month 6, the mean MELD score of 605 patients with transplant-free survival improved from 19.8 ± 4.3 to 14.7 ± 6.0 (paired t test, P < 0.001); 276 (45.6%) patients achieved > 5 point improvement in MELD score. Five predictors including age, creatinine, platelet counts, international normalized ratio, and presence of hepatic encephalopathy were independently associated with improvement in MELD score. The prediction score achieved area under the receiver-operating characteristic curve of 0.80 (95% confidence interval [CI] 0.74-0.85) and 0.82 (0.77-0.87) in the training (N = 605) and validation cohorts (N = 394), respectively, on predicting transplant-free survival with MELD score < 10 at month 6 (Figure). The proportion of patients who achieved the primary and secondary end points at month 6 increased from poor, intermediate to good treatment responders defined by cut-offs of the score (chisquare test for linear trend, P < 0.001). The 1-year transplant-free survival (95% CI) in good, intermediate, and poor responders were 72% (62%-81%), 59% (53%-66%), and 43% (37%-50%) in training cohort, and 76% (64%-86%), 63% (55%-70%), and 43% (36%-51%) in validation cohort.

Conclusion: This simple score predicts on-treatment MELD score improvement and correlates with treatment response and clinical outcomes in patients with CHB-related cirrhosis.
著者Hye Won Lee, Terry Cheuk-Fung Yip, Grace Lai-Hung Wong, Henry Lik-Yuen Chan, Yee-Kit Tse, Chung Yan Grace Lui, Sang Hoon Ahn, Vincent Wai-Sun Wong
會議名稱European Association for the Study of the Liver (EASL) The International Liver Congress™ 2019
會議論文集題名Journal of Hepatology
期次Suppl 1
頁次e659 - e659

上次更新時間 2020-05-08 於 06:01