A342 POST-TREATMENT LIVER STIFFNESS MEASUREMENTS PREDICT THE DEVELOPMENT OF LIVER-RELATED COMPLICATIONS IN PATIENTS WITH HCV CIRRHOSIS WHO ACHIEVE SVR POST-DAA THERAPY
Notice bibliographique
Résumé
Chronic hepatitis C virus (HCV) infection may lead to cirrhosis and liver-related complications (LRC) such as hepatocellular carcinoma (HCC), ascites, hepatic encephalopathy (HE) and esophageal varices. Transient elastography (TE) is a non-invasive measurement of liver fibrosis in HCV, and may predict LRC. HCV therapy with sustained virologic response (SVR) appears to decrease liver stiffness (LS) however, whether this is also associated with fewer LRC is unclear. To evaluate whether a reduction in LS post-HCV treatment with SVR is associated with a lower incidence of LRC in cirrhotic patients within 24 months of therapy. We included all cirrhotic patients (LS >12.5 kPa) treated with direct acting antivirals (DAAs) between May 1, 2013 and June 1, 2016 with SVR and pre- and post-treatment TE. We excluded patients with new/worsening LRC before post-treatment TE. Those with baseline LRC were included, and evaluated for worsening LRC, as defined by progression of post-treatment grading of the LRC compared to baseline. The absence of new/worsening LRC was recorded as ‘non-event’. ROC curves and Kaplan-Meir analysis were used. Person-time was calculated from the post-treatment TE date to the last clinic visit up to 24 months post-treatment. Of 57 patients, we excluded 4 patients with new LRC prior to post-treatment TE. TE was performed a median 32 weeks after end of treatment (IQR 28.5 weeks). 40/53 (75.5%) patients had reduction in LS, with a mean decrease of 10.7 kPa (SD 10.4). There were no differences in baseline characteristics of patients with/without decreased LS. Post-treatment, 4 events occurred during follow-up: 1 new varices, 1 new HCC, and 2 progression known varices. The incidence rate for patients with increased LS was 0.47/100 person-weeks, vs. 0.19/100 person-weeks for patients with decreased LS (RR 2.5, p=0.40, 95% CI: 0.26–24.0), with no significant difference in mean time to event (74 weeks vs. 79 weeks, respectively, p=0.55). All events occurred in individuals with LS >20.75 kPa, while no events occurred in individuals with LS score <20.75 kPa (4/20 vs. 0/33, p=0.02). This LS cutoff also had the best AUC (0.786) with a sensitivity of 100% and specificity of 67%. Post-treatment, 20/53 (37.7%) patients still had a LS above 20.75 kPa. In our cohort of patients with early cirrhosis (Child-Pugh class A), successful antiviral therapy led to a reduction in LS in most patients. Prior studies have identified a LS cutoff of 20 kPa as associated with clinically significant portal hypertension, and this was confirmed in our post-treatment cohort. Many (37.7%) patients remained above this cut-off and require LRC monitoring post-SVR. The predictive value of long-term, serial LS measurements requires evaluation. None
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».