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A combination of hepatic encephalopathy and body mass index was associated with the point of no return for improving liver functional reserve after sofosbuvir/velpatasvir treatment in patients with HCV-related decompensated cirrhosis.

AIMS
The real-world efficacy of sofosbuvir/velpatasvir (SOF/VEL) treatment for patients with hepatitis C virus (HCV)-related decompensated cirrhosis is unclear. We aimed to identify factors that improve liver functional reserve after treatment.


METHODS
This was a multicenter retrospective study of 12-week SOF/VEL treatment. Forty-eight patients with Child-Pugh (CP) class B or C were enrolled at 11 institutions. We evaluated changes in liver functional reserve at 24 weeks post-treatment.


RESULTS
At baseline, 40 and 8 patients were CP class B and C, respectively. The overall rate of sustained virologic response 12 weeks post-treatment (SVR12) was 95.8% (46/48). Serum albumin, alanine aminotransferase, and α-fetoprotein levels and the FIB-4 index were significantly improved post-treatment (P<0.05). Among patients who achieved SVR12, those with CP class A increased from 0 to 24 patients (56%) at 24 weeks post-treatment. In multivariate analysis, body mass index (BMI) ≥ 25 was an independent factor that inhibited CP class improvement (P<0.05). In decision tree analysis, after treatment, the initial divergent variable for CP class improvement was hepatic encephalopathy, followed by serum sodium level and BMI.


CONCLUSION
SOF/VEL treatment improved the liver functional reserve in patients with HCV-related decompensated cirrhosis at 24 weeks post-treatment. However, BMI ≥ 25 inhibited improvement in CP class. Additionally, decision tree analysis revealed that a combination of hepatic encephalopathy, serum sodium levels, and BMI were diversity profiles associated with no improvement liver functional reserve after the treatment. This article is protected by copyright. All rights reserved.