On-treatment changes of liver stiffness at week 26 could predict 2-year clinical outcomes in HBV-related compensated cirrhosis

Abstract Background & Aims It is unclear whether liver stiffness measurement ( LSM ) dynamic changes after anti‐ HBV treatment could predict the risk of liver‐related events ( LRE s), particularly in patients with HBV ‐related compensated cirrhosis. Methods Treatment‐naïve patients with HBV ‐related compensated cirrhosis were enrolled. All patients were under entecavir‐based antiviral therapy, and followed up every 26 weeks for 2 years. The association between LSM and LRE s was analysed by Cox proportional hazard model and Harrell C‐index analysis. Results A total of 438 patients were included in the study. At the follow‐up of 104 weeks, LRE s developed in 33/438 (7.8%) patients, including 16 episodes of decompensation, 18 HCC and 3 deaths. The median LSM remained high from 20.9, 18.6, 20.4 to 20.3 Kpa at week 0, 26, 52 and 78 among patients with LRE s, whereas the LSM decreased from 17.8, 12.3, 10.6 to 10.2 Kpa in patients without LRE s respectively. Percentage changes of LSM at 26 weeks from baseline were significantly associated with LRE s (excluding 11 cases occurred within the first 26 weeks), with a crude hazard ratio of 2.94 (95% CI : 1.73‐5.00) and an albumin‐adjusted hazard ratio of 2.47 (95% CI : 1.49‐4.11). The Harrell C‐index of these 2 models for predicting 2‐year LRE s were 0.68 (95% CI : 0.56‐0.80) and 0.75 (95% CI : 0.65‐0.85) respectively. Nomograms were developed to identify individuals at high risk for point‐of‐care application. Conclusions Dynamic changes of LSM alone, or combined with baseline albumin, could predict LRE s in patients with HBV ‐related compensated cirrhosis during antiviral therapy.