Association Between Sustained Virological Response and Adverse Liver-related Events in Patients With Decompensated Hepatitis C Virus Cirrhosis

Background & Aims Sustained virological response (SVR) improves prognosis in patients with chronic hepatitis C virus (HCV) with compensated cirrhosis, but whether a similar benefit can be obtained in decompensated patients is controversial. We studied the association between SVR and liver-related events (LREs) in patients with decompensated HCV cirrhosis. Methods We included patients with decompensated HCV cirrhosis (Child-Turcotte-Pugh [CTP] ≥7 and/or history of decompensation) treated with direct-acting antivirals. The association between SVR and LREs, and between SVR-related change in Model for End-stage Liver Disease (MELD) score and LREs were assessed. Results In total, 914 patients were included, with a median age of 54.7 years; 45% had alcohol use disorder, 87% CTP-B, and the median MELD score was 12.1. SVR was achieved in 834 patients (91.2%), with a median follow-up of 28 months. The 3-year cumulative incidence of LREs was 47.5% in patients with SVR compared with 58.6% in those without ( P < .001). Findings were consistent in multivariable analysis (adjusted hazard ratio [aHR], 0.692; P = .011). SVR was associated with a reduced risk of LREs in patients with a pretreatment MELD <15 (44.4% vs 57.6%; aHR, 0.601; P = .004), but not among patients with MELD ≥15 (62.8% vs 58.9%; aHR, 0.936; P = .801). Among patients with SVR, a ≥2-point decrease in MELD was observed in 23.4% and was not associated with a reduced risk of LREs (52.1% vs 50.7%; P = .473). Findings were consistent in multivariable analysis (aHR, 0.730; P = .122), and in patients with a pretreatment MELD score ≥15. Conclusions SVR was associated with a reduced risk of LREs in patients with decompensated HCV cirrhosis with a MELD score <15, whereas no clinical benefit was observed in those with higher MELD scores despite an SVR-associated MELD decrease.