A combination of the on‐treatment FIB FIB ‐4 and alpha‐foetoprotein predicts clinical outcomes in cirrhotic patients receiving entecavir

摘要

Abstract Background & Aims This study investigates the long‐term incidences and predictors of developing hepatocellular carcinoma ( HCC ), cirrhotic events and mortality in cirrhotic patients receiving entecavir ( ETV ) therapy. Methods We enrolled 481 nucleos(t)ide analogue‐na?ve chronic hepatitis B ( CHB ) patients who had compensated cirrhosis upon entry and had received ETV monotherapy for 12?months. Results The 8‐year cumulative incidences of developing HCC , cirrhotic events and liver‐related mortality were 26.5%, 8.62% and 10.03% respectively. Multivariate analysis revealed that diabetic mellitus ( DM ), higher fibrosis‐4 ( FIB ‐4) and alpha‐foetoprotein ( AFP ) levels at 12?months of treatment, and FIB ‐4 increase from baseline to 12?months were independent factors of HCC . FIB ‐4 and AFP levels at 12?months of treatment were also independent factors of cirrhotic events and mortality. FIB ‐4 cut‐off values of 3, 3 and 5 as well as AFP cut‐offs of 5, 5, and 9?ng/mL at 12?months of treatment were optimal for predicting HCC , cirrhotic events and mortality during therapy respectively. The FIB ‐4 and AFP levels at 12?months of treatment were assessed for the combined risk of developing clinical outcomes. The 8‐year incidences of HCC , cirrhotic events and liver‐related mortality in the subgroups with low FIB ‐4 and AFP levels were only 5.95%, 1.03% and 2.43% respectively. DM was an independent predictor of HCC and mortality. Conclusion The combination of FIB ‐4 and AFP levels at 12?months of treatment is a useful marker for predicting the development of HCC , cirrhotic events and mortality in compensated cirrhotic patients with CHB who are receiving ETV therapy.