Risk factors for liver‐related mortality of patients with hepatitis C virus after sustained virologic response to direct‐acting antiviral agents

Abstract

Background and Aim The aim of this study was to identify the factors associated with liver‐related and non‐liver‐related mortality of patients with hepatitis C virus (HCV) after sustained virologic response (SVR) to direct‐acting antiviral agents (DAAs). Methods We conducted a retrospective, single‐center cohort study of HCV patients cured by DAAs. Results A total of 330 patients with SVR to DAAs were eligible. The median follow‐up period was 3.38 years (inter‐quartile range: 2.03–4.58). The cumulative liver‐related or non‐liver‐related mortality rates at 1, 3, and 5 years were 0.00 or 1.29%, 2.87 or 3.60%, and 5.10 or 9.46, respectively. Among the liver‐related deaths, 9 of the 10 were from liver cancer. Among the non‐liver‐related deaths, the most common cause was malignancy. Through multivariate analysis using the Cox proportional hazard model, diabetes mellitus (DM, hazard ratio 13.1, 95% confidence interval 2.81–61.3) and a history of hepatocellular carcinoma (HCC, 12.8, 2.76–59.2), independently predicted liver‐related death. No variables were associated with non‐liver‐related death. Conclusion Our findings suggest that DM and a history of HCC are risk factors for liver‐related mortality of HCV patients cured by DAAs. These results indicate that early management of HCV and HCC surveillance of diabetic patients after SVR are important to increase the chance of survival. Further studies are needed to confirm the association of DM and HCC history with survival.

Prediction and surveillance of de novo HCC in patients with compensated advanced chronic liver disease after hepatitis C virus eradication with direct antiviral agents

“…Moreover, patients with a history of HCC who experienced HCC recurrence after SVR had higher mortality rates than those without recurrence (5,14). Recent studies have revealed that liver cancer accounts for 51.9%-90% of liver-related deaths in DAA-treated patients after SVR (5,15,16). These findings collectively highlight the significant impact of HCC occurrence on patient outcomes and underscore the importance of HCC surveillance despite achieving viral clearance after DAAs treatment.…”

Hepatitis C Virus Infection in the Elderly in the Era of Direct-Acting Antivirals: Evidence from Clinical Trials and Real Life

“…Regarding liver steatosis, HCV is known to contribute to lipogenesis, lipoprotein synthesis, and fatty acid oxidation, so its eradication can improve steatotic liver disease [67]. Other factors that have been described as associated with HCC development include age, male sex, genotype 1 infection, history of HCC, and pre-treatment alpha-fetoprotein levels [58,68]. The eradication of HCV infection has also been shown to be associated with a significant reduction in the risk of cardiovascular and all-cause mortality [59,61,69].…”