Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5566-5576
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5566
Longitudinal assessment of liver stiffness by transient elastography for chronic hepatitis C patients
Anya Mezina, Arunkumar Krishnan, Tinsay A Woreta, Kevin B Rubenstein, Eric Watson, Po-Hung Chen, Carla Rodriguez-Watson
Anya Mezina, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, United States
Arunkumar Krishnan, Tinsay A Woreta, Po-Hung Chen, Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD 21231, United States
Kevin B Rubenstein, Eric Watson, Carla Rodriguez-Watson, Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville 20852, United States
Carla Rodriguez-Watson, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, United States
Carla Rodriguez-Watson, Innovation in Medical Evidence Development and Surveillance (IMEDS) Program, Reagan-Udall Foundation for the FDA, Washington, 20036, United States
Author contributions: Tinsay A Woreta and Po-Hung Chen conceptualized the study; Anya Mezina, Tinsay A Woreta and Po-Hung Chen investigated the study; Anya Mezina, Tinsay A Woreta, Kevin B Rubenstein Po-Hung Chen and Carla Rodriguez-Watson did the methodology; Anya Mezina did the writing - original draft; Arunkumar Krishnan, Tinsay A Woreta, Kevin B Rubenstein Po-Hung Chen and Carla Rodriguez-Watson did the writing-review and editing; Kevin B Rubenstein did the software and visualization; Tinsay A Woreta and Eric Watson did the data curation; Arunkumar Krishnan did the validation.
Supported by the National Center for Advancing Translational Sciences, No. 5KL2TR001077-05 (to Po-Hung Chen).
Institutional review board statement: The study was reviewed and approved for publication by the Institutional Review Board of Johns Hopkins Medicine and Kaiser Permanente Mid-Atlantic States.
Informed consent statement: The need for informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carla Rodriguez-Watson, PhD, Senior Researcher, Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 E Jefferson Street, Rockville 20852, United States. crodriguezwatson@reaganudall.org
Received: August 10, 2021
Peer-review started: August 10, 2021
First decision: November 17, 2021
Revised: December 16, 2021
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 16, 2022
Processing time: 302 Days and 19.3 Hours
Abstract
BACKGROUND

Liver fibrosis is a common pathway of liver injury and is a feature of most chronic liver diseases. Fibrosis progression varies markedly in patients with hepatitis C virus (HCV). Liver stiffness has been recommended as a parameter of fibrosis progression/regression in patients with HCV.

AIM

To investigate changes in liver stiffness measured by transient elastography (TE) in a large, racially diverse cohort of United States patients with chronic hepatitis C (CHC).

METHODS

We evaluated the differences in liver stiffness between patients treated with direct-acting antiviral (DAA) therapy and untreated patients. Patients had ≥ 2 TE measurements and no prior DAA exposure. We used linear regression to measure the change in liver stiffness between first and last TE in response to treatment, controlling for age, sex, race, diabetes, smoking status, human immunodeficiency virus status, baseline alanine aminotransferase, and baseline liver stiffness. Separate regression models analyzed the change in liver stiffness as measured by kPa, stratified by cirrhosis status.

RESULTS

Of 813 patients, 419 (52%) initiated DAA treatment. Baseline liver stiffness was 12 kPa in 127 (16%). Median time between first and last TE was 11.7 and 12.7 mo among treated and untreated patients, respectively. There was no significant change in liver stiffness observed over time in either the group initiating DAA treatment (0.016 kPa/month; CI: -0.051, 0.084) or in the untreated group (0.001 kPa/mo; CI: -0.090, 0.092), controlling for covariates. A higher baseline kPa score was independently associated with decreased liver stiffness.

CONCLUSION

DAA treatment was not associated with a differential change in liver stiffness over time in patients with CHC compared to untreated patients.

Keywords: Chronic hepatitis C; Liver stiffness; Cirrhosis; Transient elastography; Direct-acting antiviral therapy

Core Tip: We evaluated changes in liver stiffness measured by transient elastography (TE) in a large, racially diverse cohort of United States patients with chronic hepatitis C (CHC). We retrospectively evaluated differences in liver stiffness between patients treated with direct-acting antiviral (DAA) therapy and untreated patients. Our study shows a higher baseline kPa score was independently associated with decreased liver stiffness, and that differences in liver stiffness may be observed on serial TE measurements in patients with higher baseline scores, irrespective of treatment effect. DAA treatment was not associated with a differential change in liver stiffness over time in patients with CHC compared to untreated patients.