Prediction of Development of Liver-Related Events by Transient Elastography in Hepatitis B Patients With Complete Virological Response on Antiviral Therapy

OBJECTIVES: In the era of antiviral therapy, the prognostic significance of serum hepatitis B virus (HBV) DNA level as a biological gradient substantially diminished, as most patients can achieve complete virological response (CVR). We aimed to investigate the predictive roles of liver stiffness (LS) for liver-related events (LREs) among patients with CVR. METHODS: We analyzed 192 patients with chronic HBV infection who achieved CVR (defined as HBV DNA < 20 IU/ml) through entecavir therapy. LS values at CVR were measured using transient elastography. LREs were defined as any cirrhotic complication, hepatocellular carcinoma, and liver-related mortality. RESULTS: The median age of the patients was 49 years, and 134 (69.8%) were male. The median LS value at CVR was 8.8 kPa. During follow-up, LREs occurred in 25 (13.0%) patients. When the population was stratified into three groups (< 8.0 kPa, 8.0-13.0 kPa, and > 13.0 kPa), cumulative LRE incidences increased significantly in association with LS values (log-rank test, P = 0.001). Patients with an LS value > 13.0 kPa (hazard ratio (HR) = 12.336, 95% confidence interval (CI) 1.335-114.010; P = 0.027) and 8.0-13.0 kPa (HR = 8.832, 95% CI 1.092-71.432; P = 0.041) were at significantly greater risk compared with those with an LS value < 8.0 kPa. On multivariate analysis, age and LS values were seen to be independent predictors (all P < 0.05). When LS values were incorporated into the REACH-B scoring model instead of serum HBV DNA level, a better predictive performance was seen compared with a conventional approach (areas under the receiver operating characteristic curve, 0.814 vs. 0.629, respectively). CONCLUSIONS: LS values at CVR are useful for predicting forthcoming LRE development. Thus, in the era of potent antiviral therapy, tailored surveillance strategies might be established based upon LS values at CVR.