Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis
Background & Aims: The latest Baveno VII consensus has provided guidance for identifying patients who have truly recompensated from those with hepatic decompensation. This study aimed to evaluate patients’ transplant-free survival in three different stages of cirrhosis. Methods: All patients...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | JHEP Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555923001453 |
| _version_ | 1827856075498455040 |
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| author | Vicki Wing-Ki Hui Grace Lai-Hung Wong Vincent Wai-Sun Wong Henry Lik-Yuen Chan Jimmy Che-To Lai Yee-Kit Tse Mandy Sze-Man Lai Tsz-Fai Yam Dongrong Li XiaoDan Fan Terry Cheuk-Fung Yip |
| author_facet | Vicki Wing-Ki Hui Grace Lai-Hung Wong Vincent Wai-Sun Wong Henry Lik-Yuen Chan Jimmy Che-To Lai Yee-Kit Tse Mandy Sze-Man Lai Tsz-Fai Yam Dongrong Li XiaoDan Fan Terry Cheuk-Fung Yip |
| author_sort | Vicki Wing-Ki Hui |
| collection | DOAJ |
| description | Background & Aims: The latest Baveno VII consensus has provided guidance for identifying patients who have truly recompensated from those with hepatic decompensation. This study aimed to evaluate patients’ transplant-free survival in three different stages of cirrhosis. Methods: All patients with chronic HBV infection and liver cirrhosis treated with oral nucleos(t)ide analogues from March 2006 to December 2022 were identified from a territory-wide database in Hong Kong. Patients with follow-up duration of <1 year were excluded. Participants were classified into three mutually exclusive groups: (1) no decompensated events (i.e. compensated group); (2) decompensated events occurred (i.e. decompensated group); or (3) decompensated events occurred followed by recompensation according to Baveno VII criteria (i.e. recompensated group). A time-dependent Cox proportional hazard model was adopted for evaluation. The follow-up period was 5 years. Results: A total of 4,701 patients with cirrhosis and HBV who were treated with entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide fumarate (TAF) were identified. During a median follow-up of 5 years (interquartile range 3.7, 5 years), 3,327 (70.8%), 1,347 (29.2%), and 265 (5.6%) patients had compensated, decompensated, and recompensated cirrhosis, respectively, at least once before the end of the study. In the time-dependent multivariable model, the recompensated group had similar transplant-free survival compared with the compensated group (adjusted hazard ratio 1.16; 95% CI 0.72–1.86; p = 0.536). The 5-year transplant-free survival rate was 89.3% for the compensated group, whereas it was 76.0% for the recompensated group, reflecting a minimal difference between the two groups. Conclusions: The clinical significance of recompensation of cirrhosis in improving patient outcomes for individuals with CHB infection was highlighted in this study. Early identification and treatment with nucleos(t)ide analogues might promote hepatic recompensation and thus reduce mortality in patients with CHB. Impact and implications: The latest Baveno VII consensus introduces the new concept of hepatic recompensation, which refers to the reversal of the structural and functional changes of cirrhosis after removal, cure, or suppression of the aetiology of cirrhosis. It is essential to investigate the transplant-free survival rates of patients who are able to achieve hepatic recompensation, as this has significant implications for the medical resources required to manage liver failure and transplantation. This study features the clinical significance of hepatic recompensation by comparing patient outcomes of those who achieve it to those who do not. The early identification and use of antiviral treatment with nucleos(t)ide analogues is a pivotal strategy to promote hepatic recompensation, which has the potential to significantly reduce mortality rates in patients with chronic HBV infection and ultimately aid in the elimination of hepatitis. |
| first_indexed | 2024-03-12T12:19:33Z |
| format | Article |
| id | doaj.art-4d7451affe3540b7987f1705e92c4b64 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-03-12T12:19:33Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-4d7451affe3540b7987f1705e92c4b642023-08-30T05:54:40ZengElsevierJHEP Reports2589-55592023-09-0159100814Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosisVicki Wing-Ki Hui0Grace Lai-Hung Wong1Vincent Wai-Sun Wong2Henry Lik-Yuen Chan3Jimmy Che-To Lai4Yee-Kit Tse5Mandy Sze-Man Lai6Tsz-Fai Yam7Dongrong Li8XiaoDan Fan9Terry Cheuk-Fung Yip10Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, ChinaMedical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Union Hospital, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China; Corresponding author. Address: Department of Medicine and Therapeutics, 5/F Prince of Wales Hospital, 30–32 Ngan Shing Street, Shatin, Hong Kong, China. Tel.: +852 3505 3125; fax: +852 2637 3852.Background & Aims: The latest Baveno VII consensus has provided guidance for identifying patients who have truly recompensated from those with hepatic decompensation. This study aimed to evaluate patients’ transplant-free survival in three different stages of cirrhosis. Methods: All patients with chronic HBV infection and liver cirrhosis treated with oral nucleos(t)ide analogues from March 2006 to December 2022 were identified from a territory-wide database in Hong Kong. Patients with follow-up duration of <1 year were excluded. Participants were classified into three mutually exclusive groups: (1) no decompensated events (i.e. compensated group); (2) decompensated events occurred (i.e. decompensated group); or (3) decompensated events occurred followed by recompensation according to Baveno VII criteria (i.e. recompensated group). A time-dependent Cox proportional hazard model was adopted for evaluation. The follow-up period was 5 years. Results: A total of 4,701 patients with cirrhosis and HBV who were treated with entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide fumarate (TAF) were identified. During a median follow-up of 5 years (interquartile range 3.7, 5 years), 3,327 (70.8%), 1,347 (29.2%), and 265 (5.6%) patients had compensated, decompensated, and recompensated cirrhosis, respectively, at least once before the end of the study. In the time-dependent multivariable model, the recompensated group had similar transplant-free survival compared with the compensated group (adjusted hazard ratio 1.16; 95% CI 0.72–1.86; p = 0.536). The 5-year transplant-free survival rate was 89.3% for the compensated group, whereas it was 76.0% for the recompensated group, reflecting a minimal difference between the two groups. Conclusions: The clinical significance of recompensation of cirrhosis in improving patient outcomes for individuals with CHB infection was highlighted in this study. Early identification and treatment with nucleos(t)ide analogues might promote hepatic recompensation and thus reduce mortality in patients with CHB. Impact and implications: The latest Baveno VII consensus introduces the new concept of hepatic recompensation, which refers to the reversal of the structural and functional changes of cirrhosis after removal, cure, or suppression of the aetiology of cirrhosis. It is essential to investigate the transplant-free survival rates of patients who are able to achieve hepatic recompensation, as this has significant implications for the medical resources required to manage liver failure and transplantation. This study features the clinical significance of hepatic recompensation by comparing patient outcomes of those who achieve it to those who do not. The early identification and use of antiviral treatment with nucleos(t)ide analogues is a pivotal strategy to promote hepatic recompensation, which has the potential to significantly reduce mortality rates in patients with chronic HBV infection and ultimately aid in the elimination of hepatitis.http://www.sciencedirect.com/science/article/pii/S2589555923001453Liver stiffness measurementPlatelet countTransient elastographyVariceal bleeding |
| spellingShingle | Vicki Wing-Ki Hui Grace Lai-Hung Wong Vincent Wai-Sun Wong Henry Lik-Yuen Chan Jimmy Che-To Lai Yee-Kit Tse Mandy Sze-Man Lai Tsz-Fai Yam Dongrong Li XiaoDan Fan Terry Cheuk-Fung Yip Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis JHEP Reports Liver stiffness measurement Platelet count Transient elastography Variceal bleeding |
| title | Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis |
| title_full | Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis |
| title_fullStr | Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis |
| title_full_unstemmed | Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis |
| title_short | Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis |
| title_sort | baveno vii criteria for recompensation predict transplant free survival in patients with hepatitis b related decompensated cirrhosis |
| topic | Liver stiffness measurement Platelet count Transient elastography Variceal bleeding |
| url | http://www.sciencedirect.com/science/article/pii/S2589555923001453 |
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