Association Between Sustained Virological Response and Adverse Liver-Related Events in Patients With Decompensated Hepatitis C Virus Cirrhosis
Bibliographic record
Abstract
BACKGROUND & AIMS: Sustained virological response (SVR) improves prognosis in patients with chronic hepatitis C virus (HCV) with compensated cirrhosis, but whether a similar benefit can be obtained in decompensated patients is controversial. We studied the association between SVR and liver-related events (LREs) in patients with decompensated HCV cirrhosis. METHODS: We included patients with decompensated HCV cirrhosis (Child-Turcotte-Pugh [CTP] ≥7 and/or history of decompensation) treated with direct-acting antivirals. The association between SVR and LREs, and between SVR-related change in Model for End-stage Liver Disease (MELD) score and LREs were assessed. RESULTS: In total, 914 patients were included, with a median age of 54.7 years; 45% had alcohol use disorder, 87% CTP-B, and the median MELD score was 12.1. SVR was achieved in 834 patients (91.2%), with a median follow-up of 28 months. The 3-year cumulative incidence of LREs was 47.5% in patients with SVR compared with 58.6% in those without (P < .001). Findings were consistent in multivariable analysis (adjusted hazard ratio [aHR], 0.692; P = .011). SVR was associated with a reduced risk of LREs in patients with a pretreatment MELD <15 (44.4% vs 57.6%; aHR, 0.601; P = .004), but not among patients with MELD ≥15 (62.8% vs 58.9%; aHR, 0.936; P = .801). Among patients with SVR, a ≥2-point decrease in MELD was observed in 23.4% and was not associated with a reduced risk of LREs (52.1% vs 50.7%; P = .473). Findings were consistent in multivariable analysis (aHR, 0.730; P = .122), and in patients with a pretreatment MELD score ≥15. CONCLUSIONS: SVR was associated with a reduced risk of LREs in patients with decompensated HCV cirrhosis with a MELD score <15, whereas no clinical benefit was observed in those with higher MELD scores despite an SVR-associated MELD decrease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".