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Aminopyrine breath test predicts liver‐related events and death in HCV‐related cirrhosis on SVR after DAA therapy
Author(s) -
Petta Salvatore,
Rini Francesca,
Calvaruso Vincenza,
Cammà Calogero,
Ciminnisi Stefania,
Di Marco Vito,
Giannini Edoardo G.,
Grimaudo Stefania,
Maria Pipitone Rosaria,
Craxì Antonio
Publication year - 2020
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14250
Subject(s) - medicine , cirrhosis , decompensation , gastroenterology , sofosbuvir , hepatic encephalopathy , hepatitis c virus , hepatitis c , proportional hazards model , antiviral therapy , ribavirin , immunology , chronic hepatitis , virus
Background & Aims In patients with hepatitis C virus (HCV)‐related advanced cirrhosis, the effects of sustained virological response (SVR) by direct antiviral agents (DAAs) on decompensation and liver deaths are less clearcut, since up to 30% of patients do not improve, and no predictors of outcome have been identified. We used 13 C‐aminopyrine breath test (ABT) to assess whether its changes can predict liver‐related outcomes after DAA treatment in patients with HCV cirrhosis. Methods Fifty consecutive patients with HCV cirrhosis were enrolled. Patients were included if they had Child A cirrhosis at risk for decompensation – defined as Child A6 (N = 22, 44%) or previous decompensation (N = 7, 14%) – or Child B cirrhosis (N = 21, 42%) eligible for DAA‐based antiviral therapy. ABT was performed at baseline and 12 weeks after the end of antiviral therapy. Patients received sofosbuvir‐based regimens. Results Aminopyrine breath test was available for all 50 patients at baseline. The 120’ cumulative dose was directly associated at regression analysis only with albumin levels ( P = .001). ABT was available at follow‐up week 12 for 41 patients (FUW12), all with SVR, and followed for a median of 25.2 months (range 12.2‐32.1 months). Lower Ʌ ABT – defined as changes of 120’ cumulative dose from FUW12 to baseline – (HR 0.97, 95% CI 0.94‐0.99; P = .02) and FUW12 hepatic encephalopathy (HR 19.0, 95% CI 1.16‐310.3; P = .03) were the only independent predictors of liver events/death at multivariate Cox regression analysis. The AUC of Ʌ ABT was good (0.87, 95% CI 0.75‐0.97), with a delta ≥0% well discriminating patients at lower vs patients at higher risk of liver‐related events/death ( P < .001). Conclusions In patients with advanced HCV cirrhosis who achieve SVR with DAA, Ʌ ABT assists in assessing the residual likelihood of liver‐related events and deaths after viral cure.