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Recompensation in treatment-naïve HBV-related decompensated cirrhosis: a 5-year multi-center observational study comparing patients with ascites and bleeding

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Abstract

Background and aims

Recompensation between patients with ascites and bleeding was unknown in treatment-naïve HBV-related decompensated cirrhosis.

Methods

In this retrospective multi-center study, treatment-naïve HBV-related decompensated patients were enrolled at first decompensating event of ascites and/or variceal bleeding. Further complications and clinical characteristics were collected using standard case report form every 6 months to year-5 of antiviral treatment. Recompensation was defined as maintaining free of decompensation for one year and achieving liver function within Child–Pugh A and/or MELD < 10.

Results

Totally, 170 (170/298, 57.0%) patients in ascites group of 298 (298/383, 77.8%) treatment-naïve decompensated patients and 33 (33/85, 38.8%) in bleeding group of 85 (85/383, 22.2%) patients, achieved recompensation. Ascites group had higher 5-year rate of recompensation than bleeding group (63.3% vs. 46.5%, p = 0.012), respectively.

Patients achieving recompensation in ascites group maintained lower rate of second decompensation than these in bleeding group (at year-5: 26.7% vs. 43.3%, p = 0.032). Specifically, recompensated patients in ascites group had predominantly 5-year rate of further ascites (24.0%) and lower rate of further bleeding (6.0%), which differed from the pattern of these in bleeding group, with lower rate of further ascites (16.0%, p = 0.599) and significantly higher rate of further bleeding (33.9%, p < 0.001). Both patients had superior long-term prognosis (death/LT rate at year-5: 0.6% vs. 3.0%, p = 0.196).

Conclusion

Ascites patients could achieve higher rate of recompensation through antiviral therapy than bleeding patients. Recompensated patients in ascites group had better prognosis in terms of preventing further bleeding.

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Availability of data and material

No additional data are available.

Abbreviations

HBV:

Hepatitis B virus

CHB:

Chronic hepatitis B

LTx:

Liver transplantation

RAAS:

Renin–angiotensin–aldosterone system

NAs:

Nucleos(t)ide analogues

HIV:

Human immunodeficiency virus

HCC:

Hepatocellular carcinoma

MELD:

Model for end-stage liver disease

EVL:

Endoscopic esophageal varix ligation

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

HBeAg:

Hepatitis B e antigen

ALB:

Albumin

TBIL:

Total bilirubin

PLT:

Platelets

WBC:

White blood count

APRI:

Aspartate aminotransferase-to-platelet ratio index

FIB-4:

Fibrosis 4 score

ETV:

Entecavir

TDF:

Tenofovir disoproxil fumarate

TAF:

Tenofovir alafenamide

LAM:

Lamivudine

ADV:

Adefovir dipivoxil

LdT:

Tebivudine

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Funding

This work was supported by Beijing Municipal Science and Technology Commission (no. Z221100007422115) and National Natural Science Foundation of China (82000570 and 82000568).

Author information

Authors and Affiliations

  1. Liver Research Center, Beijing Friendship Hospital, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Capital Medical University, 95 Yong-an Road, Xicheng District, Beijing, 100050, China

    Zhiying He, Bingqiong Wang, Xiaoning Wu, Jialing Zhou, Shuai Xia, Xiaojuan Ou, Jidong Jia & Hong You

  2. Department of Critical Care Medicine of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing, China

    Zhongjie Hu

  3. Department of Gastroenterology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

    Chunqing Zhang

  4. Department of Infectious Diseases, The First Hospital of Shanxi Medical University, Taiyuan, China

    Yanqin Hao

  5. Liver Disease Department, The Second Hospital of Nanjing, Affiliated to Medical School of South East University, Nanjing, China

    Yongfeng Yang

  6. Department of Liver and Infectious Diseases, Xiangya Hospital Central South University, Changsha, China

    Yan Huang

  7. Division of Hepatology, Liver Disease Center, the Affiliated Hospital of Qingdao University, Qingdao, China

    Wei Rao

  8. Depatment of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China

    Jing Wang

Authors
  1. Zhiying He
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  2. Bingqiong Wang
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  7. Yongfeng Yang
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  8. Yan Huang
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  10. Jing Wang
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  14. Jidong Jia
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  15. Hong You
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Contributions

Study design: HY, JDJ, XIO. Data collection: ZYH, SX, ZJH, CQZ, YQH, YFY, YH, WR, JW, JLZ. Statistical analysis: ZYH, XNW, BQW. Manuscript writing: ZYH, XNW, BQW. Critical revision of the manuscript: HY, JDJ.

Corresponding author

Correspondence to Hong You.

Ethics declarations

The study protocol was approved by the Ethics Committee at the leading site of Beijing Friendship Hospital, Capital Medical University (2021-P2-224-01) and each participating hospital, and registered at ClinicalTrials.gov (NCT05086536). It was conducted in accordance with the principles of the Declaration of Helsinki.

Conflict of interest

Zhiying He, Bingqiong Wang, Xiaoning Wu, Zhongjie Hu, Chunqing Zhang, Yanqin Hao, Yongfeng Yang, Yan Huang, Wei Rao, Jing Wang, Jialing Zhou, Shuai Xia, Xiaojuan Ou, Jidong Jia and Hong You have no conflict of interest related to this publication.

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He, Z., Wang, B., Wu, X. et al. Recompensation in treatment-naïve HBV-related decompensated cirrhosis: a 5-year multi-center observational study comparing patients with ascites and bleeding. Hepatol Int 17, 1368–1377 (2023). https://doi.org/10.1007/s12072-023-10579-w

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  • DOI: https://doi.org/10.1007/s12072-023-10579-w

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