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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

Authors
 Hye Won Lee  ;  Eun Jin Yoo  ;  Beom Kyung Kim  ;  Seung Up Kim  ;  Jun Yong Park  ;  Do Young Kim  ;  Sang Hoon Ahn  ;  Kwang-Hyub Han 
Citation
 AMERICAN JOURNAL OF GASTROENTEROLOGY, Vol.109(8) : 1241-1249, 2014 
Journal Title
AMERICAN JOURNAL OF GASTROENTEROLOGY
ISSN
 0002-9270 
Issue Date
2014
MeSH
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
Abstract
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.
Full Text
http://www.nature.com/ajg/journal/v109/n8/full/ajg2014157a.html
DOI
10.1038/ajg.2014.157
Appears in Collections:
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
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99422
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