Prognostic Value of Liver Stiffness in Advanced Chronic Liver Disease After Hepatitis C Virus Eradication

ABSTRACT Background & Aim Sustained‐virological‐response (SVR) after direct‐acting‐antiviral (DAA) therapy improves outcomes in patients with HCV‐related compensated‐advanced‐chronic‐liver‐disease (cACLD). However, it remains unclear whether absolute post‐SVR LSM or LSM reduction better predicts prognosis after SVR. This study evaluated the prognostic performance of absolute‐values‐LSM versus dynamic‐change for predicting liver‐related‐events after SVR. Methods We retrospectively analysed patients with HCV‐related cACLD treated with DAA between December 2014 and March 2022. Baseline and post‐SVR non‐invasive tests (LSM, FIB‐4 and APRI) were assessed. Predictive performance for liver‐related events was evaluated using time‐dependent receiver operating characteristic analysis. Associations between Baveno‐VII criteria for clinically significant LSM improvement and clinical outcomes were assessed using Fine–Grey competing‐risk models. Results During a median of 60 months (95%; CI 52–69), 11/135 patients (8%) developed liver‐related events. Patients who developed events had higher baseline LSM than those who remained event‐free (24 vs. 18 kPa, p  = 0.049), and higher follow‐up LSM values (20 vs. 12 kPa, p  = 0.043). Follow‐up LSM showed good discriminative ability for liver‐related events within the first 3 years after SVR (tAUC at 2 years: 0.86 [95% CI 0.75–0.97]; tAUC at 3 years: 0.82 [0.71–0.93]). Follow‐up LSM was significantly superior to ΔLSM and percentage ΔLSM at both 2 and 3 years (all p  ≤ 0.028). In competing‐risk analysis, only follow‐up LSM > 20 kPa was significantly associated with liver‐related events (subdistribution hazard ratio 5.61, p  = 0.007), whereas Baveno‐VII criteria for LSM regression were not (SHR 0.33, p  = 0.097). Conclusions Absolute post‐treatment‐LSM provides stronger prognostic information than dynamic changes from baseline. These findings support repeated post‐SVR LSM assessment for risk stratification suggesting the relevance of residual liver disease in predicting liver‐related outcomes.