Pretreatment Predictors Associated with Improvement in Hepatitis C Virus Related Decompensated Cirrhosis after Direct-Acting Antiviral Therapy

Background and Aim: The availability of hepatitis C virus (HCV) direct-acting antivirals (DAAs) has led to a paradigm change in the care of HCV related decompensated cirrhosis. Achieving a stained virologic response (SVR) is associated with considerable improvements in both Child-Turcotte- Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores in decompensated cirrhosis. We aimed to evaluate the pretreatment predictors associated with improvement in CTP B cirrhosis after DAAs and evaluate the efficacy and safety of DAAs in these patients.

Patients and Methods: A prospective study conducted on 213 decompensated patients (CTP B, 134 received DAAs for 24 weeks and 79 for 12 weeks). Clinical and laboratory data obtained at baseline, during treatment, 12 weeks after end of treatment (EOT), 36 weeks after treatment start, and 24 weeks after SVR.

Results: We had 48.4 % and 55.9 % had improved to CTP A at 36 weeks of treatment start and 24 weeks after SVR respectively. A high baseline BE3A score (which includes Body mass index (BMI), Encephalopathy, Ascites, Alanine aminotransferase (ALT) and Albumin) was the significant predictor of attaining CTP A at 36 weeks of treatment start, while high baseline ALT (> 60 IU/L) was the significant predictor of attaining CTP A at 24 weeks after SVR. SVR 12 achieved in 97.3% and DAAs were safe with mild tolerable adverse events.

Conclusion: High baseline ALT and BE3A score were the significant predictors of hepatic improvement from CTP B to CTP A after DAAs. HCV DAAs were safe and effective with high SVR rates (97.3%) in decompensated cirrhosis.