Posttreatment nonalcoholic fatty liver disease fibrosis scores for predicting liver‐related complications in patients with chronic hepatitis C receiving direct‐acting antiviral agents

• Published in: Journal of viral hepatitis Vol. 29; no. 9; pp. 785 - 794
• Main Authors: Hsu, Wei‐Fan, Lai, Hsueh‐Chou, Chuang, Po‐Heng, Su, Wen‐Pang, Chen, Sheng‐Hung, Chen, Hung‐Yao, Wang, Hung‐Wei, Huang, Guan‐Tarn, Peng, Cheng‐Yuan
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.09.2022
• Subjects: Antiviral agents; Bilirubin; chronic hepatitis C; direct‐acting antiviral agent; Dyslipidemia; Fatty liver; Fibrosis; Hepatitis; Hepatitis C; Hepatocellular carcinoma; Interferon; Liver cancer; Liver diseases; liver‐related complication; Metabolic syndrome; nonalcoholic fatty liver disease fibrosis score; Steatosis; direct-acting antiviral agent; hepatocellular carcinoma; liver-related complication; nonalcoholic fatty liver disease fibrosis score; chronic hepatitis C
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/jvh.13715

Patients with chronic hepatitis C (CHC) have a higher prevalence of hepatic steatosis and dyslipidaemia than healthy individuals. We analysed noninvasive fibrosis assessments, especially nonalcoholic fatty liver disease (NAFLD)‐related noninvasive fibrosis tests, for predicting liver‐related complications and hepatocellular carcinoma (HCC) occurrence in patients with CHC. This retrospective study enrolled 590 consecutive patients with CHC having a sustained virologic response (SVR) to direct‐acting antiviral agent (DAA) therapy. The NAFLD fibrosis score (NFS) exhibiting the highest value of area under the receiver operating characteristic curve (AUROC) was selected for comparison with the fibrosis‐4 index (FIB‐4). Of the 590 patients, 188 had metabolic syndrome. A multivariate Cox regression analysis identified total bilirubin at 3 or 6 months after DAA therapy (PW12), NFS at PW12 (hazard ratio [HR]: 2.125, 95% confidence interval [CI]: 1.058–4.267, p = .034) and alpha‐fetoprotein (AFP) at PW12 (HR: 1.071, 95% CI: 1.005–1.142, p = .034) as the independent predictors of liver‐related complications in all patients. In patients with metabolic syndrome, NFS and AFP values at PW12 were independent predictors of liver‐related complications and HCC occurrence. Time‐dependent NFS AUROC values at PW12 for 1‐, 2‐ and 3‐year liver‐related complications were higher than NFS values at baseline in patients with metabolic syndrome. NFS at baseline or PW12 is a more effective predictor of liver‐related complications than FIB‐4 values in all patients. NFS at PW12 may be a useful predictor of liver‐related complications and HCC development in patients with CHC with an SVR to DAA therapy, especially in those with metabolic syndrome.