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Prediction of development of liver-related events by transient elastography in Hepatitis B patients with complete virological response on antiviral therapy

 Hye Won Lee  ;  Eun Jin Yoo  ;  Beom Kyung Kim  ;  Seung Up Kim  ;  Jun Yong Park  ;  Do Young Kim  ;  Sang Hoon Ahn  ;  Kwang-Hyub Han 
 AMERICAN JOURNAL OF GASTROENTEROLOGY, Vol.109(8) : 1241-1249, 2014 
Journal Title
Issue Date
Adult ; Antiviral Agents/therapeutic use* ; Biomarkers, Tumor/blood ; Elasticity Imaging Techniques* ; Female ; Guanine/analogs & derivatives* ; Guanine/therapeutic use ; Hepatitis B, Chronic/diagnostic imaging* ; Hepatitis B, Chronic/drug therapy* ; Humans ; Liver Function Tests ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Republic of Korea
OBJECTIVES: In the era of antiviral therapy, the prognostic significance of serum hepatitis B virus (HBV) DNA level as a biological gradient substantially diminished, as most patients can achieve complete virological response (CVR). We aimed to investigate the predictive roles of liver stiffness (LS) for liver-related events (LREs) among patients with CVR.
METHODS: We analyzed 192 patients with chronic HBV infection who achieved CVR (defined as HBV DNA <20 IU/ml) through entecavir therapy. LS values at CVR were measured using transient elastography. LREs were defined as any cirrhotic complication, hepatocellular carcinoma, and liver-related mortality.
RESULTS: The median age of the patients was 49 years, and 134 (69.8%) were male. The median LS value at CVR was 8.8 kPa. During follow-up, LREs occurred in 25 (13.0%) patients. When the population was stratified into three groups (<8.0 kPa, 8.0–13.0 kPa, and >13.0 kPa), cumulative LRE incidences increased significantly in association with LS values (log-rank test, P=0.001). Patients with an LS value >13.0 kPa (hazard ratio (HR)=12.336, 95% confidence interval (CI) 1.335–114.010; P=0.027) and 8.0–13.0 kPa (HR=8.832, 95% CI 1.092–71.432; P=0.041) were at significantly greater risk compared with those with an LS value <8.0 kPa. On multivariate analysis, age and LS values were seen to be independent predictors (all P<0.05). When LS values were incorporated into the REACH-B scoring model instead of serum HBV DNA level, a better predictive performance was seen compared with a conventional approach (areas under the receiver operating characteristic curve, 0.814 vs. 0.629, respectively).
CONCLUSIONS: LS values at CVR are useful for predicting forthcoming LRE development. Thus, in the era of potent antiviral therapy, tailored surveillance strategies might be established based upon LS values at CVR.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Yoo, Eun Jin(유은진)
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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