title: Prediction of development of liver-related events by transient elastography in hepatitis B patients with complete virological response on antiviral therapy.
abstract: OBJECTIVE
  In the era of antiviral therapy, the prognostic significance of serum hepatitis B virus (HBV) DNA level as a biological gradient substantially diminished, as most patients can achieve complete virological response (CVR). We aimed to investigate the predictive roles of liver stiffness (LS) for liver-related events (LREs) among patients with CVR.
  
  
  METHODS
  We analyzed 192 patients with chronic HBV infection who achieved CVR (defined as HBV DNA <20 IU/ml) through entecavir therapy. LS values at CVR were measured using transient elastography. LREs were defined as any cirrhotic complication, hepatocellular carcinoma, and liver-related mortality.
  
  
  RESULTS
  The median age of the patients was 49 years, and 134 (69.8%) were male. The median LS value at CVR was 8.8 kPa. During follow-up, LREs occurred in 25 (13.0%) patients. When the population was stratified into three groups (<8.0 kPa, 8.0-13.0 kPa, and >13.0 kPa), cumulative LRE incidences increased significantly in association with LS values (log-rank test, P=0.001). Patients with an LS value >13.0 kPa (hazard ratio (HR)=12.336, 95% confidence interval (CI) 1.335-114.010; P=0.027) and 8.0-13.0 kPa (HR=8.832, 95% CI 1.092-71.432; P=0.041) were at significantly greater risk compared with those with an LS value <8.0 kPa. On multivariate analysis, age and LS values were seen to be independent predictors (all P<0.05). When LS values were incorporated into the REACH-B scoring model instead of serum HBV DNA level, a better predictive performance was seen compared with a conventional approach (areas under the receiver operating characteristic curve, 0.814 vs. 0.629, respectively).
  
  
  CONCLUSIONS
  LS values at CVR are useful for predicting forthcoming LRE development. Thus, in the era of potent antiviral therapy, tailored surveillance strategies might be established based upon LS values at CVR.
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] The first two authors contributed equally to this work.
authors: Hye Won
authors: HW
authors: Lee
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] The first two authors contributed equally to this work.
authors: Eun Jin
authors: EJ
authors: Yoo
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Beom Kyung
authors: BK
authors: Kim
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Seung Up
authors: SU
authors: Kim
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Jun Yong
authors: JY
authors: Park
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Do Young
authors: DY
authors: Kim
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Brain Korea 21 Project for Medical Science, Seoul, Korea.
authors: Sang Hoon
authors: SH
authors: Ahn
authors: 1] Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea [2] Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea [3] Brain Korea 21 Project for Medical Science, Seoul, Korea.
authors: Kwang-Hyub
authors: KH
authors: Han
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D054459:Elasticity Imaging Techniques; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D056910:Republic of Korea
chemical_list: D000998:Antiviral Agents; D014408:Biomarkers, Tumor; C413685:entecavir; D006147:Guanine