Hypergammaglobulinemia before Starting DAA Therapy Is A Strong Predictor of Disease Progression in Cirrhotic Patients Even after HCV Clearance

• Published in: Journal of personalized medicine 2022-10, Vol.12 (11), p.1794
• Main Authors: Franzè, Maria Stella, Filomia, Roberto, Caccamo, Gaia, Pitrone, Concetta, Alibrandi, Angela, Saitta, Carlo, Caspanello, Amalia Rita, Asero, Clelia, Arcadi, Vittoria, Raimondo, Giovanni, Cacciola, Irene
• Format: Article
• Language: English
• Subjects: Antiviral agents; Ascites; Biopsy; Body mass index; Cirrhosis; Creatinine; Death; Diabetes; Esophagus; Genotype & phenotype; Globulins; Hematology; Hepatitis B; Hepatitis C; Hepatocellular carcinoma; Hypergammaglobulinemia; Hypertension; Infections; Liver cancer; Liver cirrhosis; Liver diseases; Medical prognosis; Patients; Precision medicine; Regression analysis; Statistical analysis; Transplants & implants; Ultrasonic imaging
• ISSN: 2075-4426; 2075-4426
• DOI: 10.3390/jpm12111794

The predictive factors of long-term clinical benefits in patients with hepatitis C virus (HCV)—related liver cirrhosis after Direct Antiviral Agents (DAA) treatment are still undefined. The aim of this study was to identify any predictors of liver failure, hepatocellular carcinoma (HCC) and/or death in patients with compensated liver cirrhosis who achieved the sustained virological response (SVR). To this purpose, 324 consecutive cirrhotic patients who started DAA treatment from 1 April 2015 to 31 December 2016 were retrospectively analyzed. All patients were followed up for a median time of 63 months (range 19−77) through clinical/biochemical/instrumental examinations performed at baseline and after stopping the DAA treatment. At the end of the evaluation, 230 (71%) individuals showed stable clinical liver disease over time, 43 (13.3%) developed HCC, and 24 (7.4%) developed hepatic decompensation without HCC. Overall, 49 (15,1%) patients died. Multivariate regression analysis showed that hepatic decompensation was significantly associated with at baseline older age, higher liver stiffness, higher spleen longitudinal size values and hypergammaglobulinemia (p = 0.003, p = 0.005, p = 0.001, p = 0.029, respectively). HCC development was significantly associated with hypergammaglobulinemia (p < 0.001). Death was associated with older age and hypergammaglobulinemia (p < 0.001 and p = 0.007, respectively). Finally, survival analysis confirmed that patients with gamma globulin levels ≥ 1.8 gr/dl had a significantly higher risk of death compared to those with gamma globulin levels < 1.8 gr/dl (p < 0.001). In conclusion, hypergammaglobulinemia before starting DAA therapy represents a strong predictor of hepatic decompensation, HCC and death in cirrhotic patients even after HCV clearance.