Non-invasive fibrosis tests to predict complications in compensated post-hepatitis C cirrhosis

Background and Aims: Markers predicting complications of post-hepatitis C cirrhosis are needed. We asked whether changes in noninvasive markers of fibrosis can predict liver-related complications. Methods: This was a case-controlled study using a prospective national cohort (ANRS-CO12CIRVIR) of 1323 HCV-infected patients with compensated cirrhosis: 97 patients who developed liver-related complications such as hepatocellular carcinoma or hepatic decompensation (cases) matched in age, sex and follow-up duration were compared with 257 patients without complications (controls). Actitest/Fibrotest (TM), Inflameter/Fibrometer (TM), ELFTM and Fibroscan (TM) were performed at baseline and yearly. Samples based on Propensity score matching were built and mixed linear models performed. Outcomes in a sustained virological response (SVR) negative population and a SVR-positive population were also described. Results: At baseline, all characteristics of patients were similar between the groups. All fibrosis tests were statistically higher for cases compared to controls, FibroscanTM excepted: FibrotestTM: 0.83 +/- 0.13 vs. 0.77 +/- 0.16; FibrometerTM: 0.93 +/- 0.07 vs. 0.90 +/- 0.11; ELFTM: 11.4 +/- 1.0 vs. 11.0 +/- 1.2 (P < 0.02). The mean follow-up was 5.7 +/- 1.9 years. Over a 3-year period, the significant difference in fibrosis marker values between cases and controls remained constant; with a trend toward a decrease in inflammation markers in controls, independent of SVR status. Conclusions: Baseline noninvasive serum fibrosis and inflammation markers were significantly higher in patients developing a complication than in controls. During the follow-up only inflammatory markers decreased in controls, but not in cases, and thus could potentially be used to predict the occurrence of complications in cirrhotic patients. (C) 2019 Published by Elsevier Masson SAS.