title: Early on-treatment change in liver stiffness predicts development of liver-related events in chronic hepatitis B patients receiving antiviral therapy.
abstract: OBJECTIVE
  Monitoring fibrosis is mandatory for detailed prognostification in patients with chronic liver disease. We developed optimized cut-offs for liver stiffness (LS) values, based on the histological subclassification of cirrhosis, and investigated whether early on-treatment changes in LS values can predict long-term prognosis in patients with hepatitis B virus (HBV)-related advanced liver fibrosis receiving antiviral therapy.
  
  
  METHODS
  Between 2005 and 2008, 103 patients with F3 or F4 fibrosis on liver biopsy were enrolled prospectively. Cirrhosis was subclassified into three groups (F4A, F4B and F4C) according to Laennec system. The primary end-point was occurrence of liver-related event (LRE), including decompensation, hepatocellular carcinoma and liver-related death.
  
  
  RESULTS
  Suggested LS cut-offs for predicting F4B-FC (vs. F3-F4A) and F4C (vs. F3-F4B) were 11.6 and 18.2 kPa respectively. As proportions of patients with LRE occurrence increased according to histological subclassifications stage F3-4A vs. F4B-4C (7.4% vs. 17.1%) and stage F3-4B vs. F4C (13.8% vs. 18.8%), they also increased according to LS cut-off value of 11.6 kPa (5.9% vs. 23.1%) and 18.2 kPa (9.8% vs. 33.3%) respectively (all P < 0.05). Similarly, according to stratified LS values (<11.6, 11.6-18.2 and ≥18.2 kPa), overall incidence of LREs and each constituent event increased significantly (all P < 0.05). In addition, the observed changes in LS values between baseline and 6 months of follow-up showed significant correlations with LRE development.
  
  
  CONCLUSIONS
  Stratified LS values based on Laennec system and dynamic changes in LS values on follow-up may be helpful in assessing risk of LREs in subjects with HBV-related advanced liver fibrosis receiving antiviral therapy.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom K
authors.initials: BK
authors.lastname: Kim
authors.forename: Hyun J
authors.initials: HJ
authors.lastname: Oh
authors.forename: Jun Y
authors.initials: JY
authors.lastname: Park
authors.forename: Do Y
authors.initials: DY
authors.lastname: Kim
authors.forename: Sang H
authors.initials: SH
authors.lastname: Ahn
authors.forename: Kwang H
authors.initials: KH
authors.lastname: Han
authors.forename: Yehyun
authors.initials: Y
authors.lastname: Park
authors.forename: Eun J
authors.initials: EJ
authors.lastname: Yoo
authors.forename: Young N
authors.initials: YN
authors.lastname: Park
authors.forename: Seung U
authors.initials: SU
authors.lastname: Kim
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D054459:Elasticity Imaging Techniques / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy; D006652:Histological Techniques; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D056910:Republic of Korea; D018709:Statistics, Nonparametric
chemical_list: D000998:Antiviral Agents