Aminopyrine breath test predicts liver-related events and death in HCV-related cirrhosis on SVR after DAA therapy

Stefania Grimaudo, Vito Di Marco, Calogero Camma', Salvatore Petta, Antonio Craxi, Vincenza Calvaruso, Edoardo G. Giannini, Francesca Rini, Stefania Ciminnisi

Risultato della ricerca: Article

Abstract

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 13C-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.
Lingua originaleEnglish
Numero di pagine9
RivistaLiver International
Stato di pubblicazionePublished - 2019

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Aminopyrine
Breath Tests
Hepacivirus
Antiviral Agents
Fibrosis
Liver
Therapeutics
Regression Analysis
Hepatic Encephalopathy
Area Under Curve
Albumins

All Science Journal Classification (ASJC) codes

  • Hepatology

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@article{f94add1bd0c34b23ac210d54dc1f9628,
title = "Aminopyrine breath test predicts liver-related events and death in HCV-related cirrhosis on SVR after DAA therapy",
abstract = "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 13C-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&nbsp;=&nbsp;22, 44{\%}) or previous decompensation (N&nbsp;=&nbsp;7, 14{\%}) – or Child B cirrhosis (N&nbsp;=&nbsp;21, 42{\%}) eligible for DAA-based antiviral therapy. ABT was performed at baseline and 12&nbsp;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&nbsp;=.001). ABT was available at follow-up week 12 for 41 patients (FUW12), all with SVR, and followed for a median of 25.2&nbsp;months (range 12.2-32.1&nbsp;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&nbsp;=.02) and FUW12 hepatic encephalopathy (HR 19.0, 95{\%} CI 1.16-310.3; P&nbsp;=.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&nbsp;<.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.",
author = "Stefania Grimaudo and {Di Marco}, Vito and Calogero Camma' and Salvatore Petta and Antonio Craxi and Vincenza Calvaruso and Giannini, {Edoardo G.} and Francesca Rini and Stefania Ciminnisi",
year = "2019",
language = "English",
journal = "Liver International",
issn = "1478-3223",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Aminopyrine breath test predicts liver-related events and death in HCV-related cirrhosis on SVR after DAA therapy

AU - Grimaudo, Stefania

AU - Di Marco, Vito

AU - Camma', Calogero

AU - Petta, Salvatore

AU - Craxi, Antonio

AU - Calvaruso, Vincenza

AU - Giannini, Edoardo G.

AU - Rini, Francesca

AU - Ciminnisi, Stefania

PY - 2019

Y1 - 2019

N2 - 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 13C-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&nbsp;=&nbsp;22, 44%) or previous decompensation (N&nbsp;=&nbsp;7, 14%) – or Child B cirrhosis (N&nbsp;=&nbsp;21, 42%) eligible for DAA-based antiviral therapy. ABT was performed at baseline and 12&nbsp;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&nbsp;=.001). ABT was available at follow-up week 12 for 41 patients (FUW12), all with SVR, and followed for a median of 25.2&nbsp;months (range 12.2-32.1&nbsp;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&nbsp;=.02) and FUW12 hepatic encephalopathy (HR 19.0, 95% CI 1.16-310.3; P&nbsp;=.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&nbsp;<.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.

AB - 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 13C-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&nbsp;=&nbsp;22, 44%) or previous decompensation (N&nbsp;=&nbsp;7, 14%) – or Child B cirrhosis (N&nbsp;=&nbsp;21, 42%) eligible for DAA-based antiviral therapy. ABT was performed at baseline and 12&nbsp;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&nbsp;=.001). ABT was available at follow-up week 12 for 41 patients (FUW12), all with SVR, and followed for a median of 25.2&nbsp;months (range 12.2-32.1&nbsp;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&nbsp;=.02) and FUW12 hepatic encephalopathy (HR 19.0, 95% CI 1.16-310.3; P&nbsp;=.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&nbsp;<.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.

UR - http://hdl.handle.net/10447/387174

UR - http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1478-3231

M3 - Article

JO - Liver International

JF - Liver International

SN - 1478-3223

ER -