Long-term survival and clinical outcomes following direct-acting antiviral (DAA) treatment in HCV decompensated cirrhosis in Brazil: a real-world study

Introduction: The outcomes regarding portal hypertension-related complications and infec-tions after HCV cure in decompensated cirrhosis are scarcely reported. We aimed to iden-tify the predictors of survival and to evaluate the frequency of decompensation events of cirrhosis, including hepatocellular carcinoma (HCC), portal hypertension complications and infections in a cohort of decompensated cirrhotic with sustained virological response (SVR) in a real-world scenario.Patients and methods: This was a prospective study in consecutive HCV-infected patients with decompensated cirrhosis who achieved SVR after direct-acting antiviral (DAA) treat-ment. At baseline, clinical and laboratory data were recorded. Patients were followed until development of outcomes regarding further decompensation, death, or liver transplant. A Cox-regression analysis was performed and survival curves were constructed using the Kaplan Mayer method. Results: One hundred and thirty patients (age 60 9 years, 64% female, 70% genotype 1) were included and followed-up through three years. SVR was associated with a lower prev-alence of ascites and an improvement in Child-Pugh and MELD scores. One and three-year probability of transplant-free survival was 93% and 66%, respectively. Variables related to three-years survival were MELD < 11 (HR 1.24, 95% CI 1.13-1.37) and absence of ascites (HR 2.03, 95% CI 0.99-4.13) after the end of treatment (91% versus 37% in patients with ascites and a higher MELD, p < 0.001).Conclusions: Decompensated cirrhotics with SVR and a low MELD without ascites have an excellent long-term prognosis. On the contrary, those with higher MELD and ascites have a low probability of survival even in the short term and might be evaluated for liver trans-plantation.(c) 2022 Published by Elsevier Espana, S.L.U. on behalf of Sociedade Brasileira de Infectologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Automated summary

The outcomes of portal hypertension-related complications and infections after HCV cure in decompensated cirrhosis are rarely reported. This study aimed to identify the predictors of survival and evaluate the frequency of decompensation events in a cohort of decompensated cirrhotic patients with sustained virological response (SVR). The results showed that decompensated cirrhotics with SVR and a low MELD without ascites have a good long-term prognosis, while those with higher MELD and ascites have a low probability of survival even in the short term and might be evaluated for liver transplantation.