Clinical factors to predict changes of esophagogastric varices after sustained viral response with direct-acting antiviral therapy

期刊论文
发表日期：

2024年11月15日

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Takao Watanabe,
Yoshio Tokumoto,
Hironori Ochi,
Toshie Mashiba,
Fujimasa Tada,
Atsushi Hiraoka,
Yoshiyasu Kisaka,
Yoshinori Tanaka,
Sen Yagi,
Seiji Nakanishi,
Kotaro Sunago,
Kazuhiko Yamauchi,
Makoto Higashino,
Kana Hirooka,
Masaaki Tange,
Atsushi Yukimoto,
Makoto Morita,
Yuki Okazaki,
Masashi Hirooka,
Masanori Abe,
Yoichi Hiasa

摘要

Background

The clinical course of esophagogastric varices (EGV) after sustained virological response (SVR) with direct-acting antiviral (DAA) therapy has not been clearly elucidated. The predictors for the worsening/improvement of EGV after SVR with DAA therapy were investigated.

Methods

Of the cirrhosis patients who achieved SVR with DAA therapy, 328 patients who underwent endoscopic examinations both before and after DAA therapy were enrolled. The predictors of EGV worsening or improvement were investigated.

Results

Multivariate analysis identified a history of ascites retention, albumin at baseline, and MELD score at baseline as independent factors that contributed to EGV exacerbation. On multivariate analysis, two factors, BMI and platelet count, were related to EGV improvement. An integrated scoring system was created using these risk factors with or without weighting according to each hazard ratio, and the patients were divided into three groups. A scoring system with weighting of each factor appeared to be more useful, with fewer intermediate patients and more cases classified into the low-risk and high-risk groups.

Conclusion

Esophagogastric varices after SVR have a varied clinical course. Using this scoring system that can accurately predict EGV outcomes in clinical settings, it may be feasible to establish a risk-based EGV surveillance plan following SVR.