Two-year free of complications during antiviral therapy predicts stable re-compensation in immediate-treatment HBV-related decompensated cirrhosis

Abstract

Background and aims

Disease progression could be altered or even reversed in decompensated patients with HBV-related cirrhosis once they initiate antiviral therapy. However, little is known about the stable re-compensation in these patients.

Methods

In this retrospective study, HBV-related liver cirrhosis patients were consecutively enrolled at the first decompensated event of ascites or variceal hemorrhage (VH), and divided into immediate-treatment, on-treatment and delayed/no treatment groups. Patients were followed up to at least presence of second decompensation event or to June 2021. Re-compensation was defined as patients who did not occur second (further) decompensation during follow-up.

Results

A total of 130 HBV-related decompensated cirrhotic patients were included with a median follow-up of 61.0 (41.6, 72.0) months. The cumulative incidence of re-compensation at year 6 was 39.0, 9.8 and 6.6 in immediate-treatment, on-treatment and delayed/no treatment group (p = 0.001). Among 87 patients in immediate-treatment group, thirty-seven (37/87, 42.5%) were recognized as stable re-compensation. Seventy percent (35/50) of second decompensated events occurred in the first 2 years. In patients free of 2-year decompensated complications, about 71.2% (37/52) maintained stable re-compensation. The cumulative incidence of death (and/or transplantation) and HCC in patients free of 2-year decompensated complications or not was 2.9 vs. 27.3% (HR 9.4, 95% CI 2.2–40.0, p = 0.002) and 12.6 vs. 37.7% (HR 4.5, 95% CI 1.5–13.3, p = 0.006), respectively.

Conclusions

In decompensated patients with HBV-related cirrhosis, about 40% in immediate-treatment group maintained stable re-compensation during 6 years of antiviral therapy. Two-year free of complications could predict stable re-compensation.

Keywords:

• Decompensated cirrhosis
• re-compensation
• Hepatitis B Virus
• immediate-treatment

Ethical approval

The study protocol was approved by the Ethics Committee of Beijing Friendship Hospital, Capital Medical University (2019-P2-247-02). This study was conducted in accordance with the principles of the Declaration of Helsinki.

Author contributions

Study design: HY

Data collection: ZYH, YT, XJO, JDJ

Statistical analysis: ZYH, JLZ, SSW, XNW, YMS

Manuscript writing: ZYH, BQW, XNW

Critical revision of the manuscript: HY

Disclosure statement

No conflict of interest was declared by the author(s).

Data availability statement

No additional data are available.

Additional information

Funding

This work was supported by grants from National Science and Technology Major Project [2018ZX10302204, 2018ZX10302204-004], the project from Beijing Municipal Science and Technology Commission [Z191100007619037] and National Natural Science Foundation of China [82000568].