Metabolic management after sustained virologic response in elderly patients with hepatitis C virus: A multicenter study

Author:

Sano Tomoya12ORCID,Amano Keisuke12,Ide Tatsuya123,Isoda Hiroshi4,Honma Yuichi5ORCID,Morita Yasuyo6,Yano Yoichi7,Nakamura Hiroki8,Itano Satoshi9,Miyajima Ichiro10,Shirachi Miki11,Kuwahara Reiichiro112,Ohno Miki13,Kawaguchi Toshihiro14ORCID,Tsutsumi Tsubasa1ORCID,Nakano Dan1,Arinaga‐Hino Teruko1ORCID,Kawaguchi Machiko1,Eguchi Yuichiro415,Torimura Takuji16,Takahashi Hirokazu4ORCID,Harada Masaru5,Kawaguchi Takumi1ORCID,

Affiliation:

1. Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume Japan

2. Fukuoka Consulting and Support Center for Liver Diseases Kurume Japan

3. Department of Gastroenterology Kurume University Medical Center Kurume Japan

4. Liver Center Saga University Hospital Faculty of Medicine Saga University Saga Japan

5. Third Department of Internal Medicine University of Occupational and Environmental Health Kitakyushu Japan

6. Department of Gastroenterology Nagata Hospital Yanagawa Japan

7. Division of Gastroenterology Department of Medicine Saga Central Hospital Saga Japan

8. Department of Gastroenterology Shin Koga Hospital Kurume Japan

9. Department of Gastroenterology Kurume Chuo Hospital Kurume Japan

10. Department of Gastroenterology Kumamoto Central Hospital Kikuchi Japan

11. Department of Gastroenterology Chikugo City Hospital Chikugo Japan

12. Department of Gastroenterology Oita Saiseikai Hita Hospital Hita Japan

13. Department of Gastroenterology and Hepatology Yanagawa Hospital Yanagawa Japan

14. Division of Gastroenterology Department of Medicine Social Insurance Tagawa Hospital Tagawa Japan

15. Loco Medical General Institute Ogi Japan

16. Department of Gastroenterology Omuta City Hospital Omuta Japan

Abstract

AbstractAimsHepatocellular carcinoma (HCC) develops even in patients with hepatitis C virus (HCV) eradication by direct‐acting antiviral agents. Fatty liver and metabolic dysfunction are becoming major etiologies of HCC. We aimed to evaluate the impact of metabolic dysfunction‐associated steatotic liver disease (MASLD), a new definition of steatotic liver disease, on the development of HCC after HCV eradication.MethodsWe enrolled 1280 elderly patients with HCV eradication and no history of HCC. We evaluated α‐fetoprotein (AFP), Fibrosis‐4 index and MASLD after 24 weeks of sustained virological response. Decision tree analysis was used to investigate factors associated with HCC development after HCV eradication.ResultsA total of 86 patients (6.7%) developed HCC during the follow‐up period (35.8 ± 23.7 months). On multivariate analysis, serum AFP level (HR 1.08, CI 1.04–1.11, P = 0.0008), Fibrosis‐4 index (HR 1.17, CI 1.08–1.26, P = 0.0007), and MASLD (HR 3.04, CI 1.40–6.58, P = 0.0125) at 24 weeks of sustained virological response were independent factors associated with HCC development. In decision tree analysis, the initial classifier for HCC development was AFP ≥7 ng/mL. However, in patients with AFP <7 ng/mL, MASLD, rather than Fibrosis‐4 index, was the classifier for HCC development. No significant difference was observed in the cumulative incidence of HCC between patients with AFP ≥7 ng/mL and patients with AFP <7 ng/mL and MASLD.ConclusionMASLD at 24 weeks of sustained virological response is a risk factor for HCC development in elderly patients with HCV eradication. Additionally, decision tree analysis revealed that MASLD was associated with HCC development, even in patients with serum AFP levels <7 ng/mL.

Funder

Japan Agency for Medical Research and Development

Publisher

Wiley

Subject

Infectious Diseases,Hepatology

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