• Chun-Ming Hong, Tung-Hung Su, Shih-Jer Hsu, Tai-Chung Tseng, Chen-Hua Liu, Hung-Chih Yang, Jia-Horng Kao, Pei-Jer Chen, Pin-Nan Cheng, Chao-Hung Hung, Cheng-Yuan Peng, Chien-Hung Chen, Chun-Yen Lin, Hsing-Tao Kuo, Han-Chieh Lin, Yi-Hsiang Huang, Chi-Yi Chen, Chih-Lin Lin, Pei-Chien Tsai, Yu-Syuan Zeng, Chia-Yen Dai, Wan-Long Chuang, Jee-Fu Huang, Chung-Feng Huang, Ming-Lun Yeh, Ming-Lung Yu, and Chun-Jen Liu.
• Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
• J Formos Med Assoc. 2024 Nov 1.

Background And AimsDirect-acting antiviral agents (DAAs) achieve high sustained virologic response (SVR) in chronic hepatitis C patients; yet a proportion of patients still experience de novo liver complications after SVR. Identification of risk factors is clinically important. FIB-4 index is a useful noninvasive tool to assess fibrosis, while neutrophil-to-lymphocyte ratio (NLR) is a biomarker for systemic inflammation. Our study aimed to investigate whether the addition of NLR can increase the prediction power of pre-DAA FIB-4 for de novo liver complications after SVR.MethodsWe recruited patients via The Taiwan HCV Registry (TACR) and National Health Insurance Registry Database. The inclusion criteria were patients who achieved SVR12 after DAA and were followed for at least 24 months after SVR12. Liver complications included ascites, hepatic encephalopathy, variceal bleeding, and HCC.ResultsTotally 7657 patients were recruited from 2013 to 2018. Among them, 3674 patients (48.0%) had a FIB-4 value > 3.25 and 491 patients (6.4%) had a NLR >4 before DAA. After two-year of follow-up after SVR 12, 214 patients (2.8%) developed de novo liver complications. Factors associated with liver complications included male gender, diabetes mellitus, hyperlipidemia, chronic kidney disease, and pre-DAA FIB-4 >3.25 in multivariate analyses. Addition of NLR slightly did not increase the power of predicting liver complications.ConclusionsThe overall incidence of de novo liver complications after SVR is low during short-term follow-up. Elevated pre-DAA FIB-4 is associated with de novo liver complications after SVR, whereas the addition of pre-DAA NLR does not increase the prediction power.Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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