Addition of neutrophil-to-lymphocyte ratio to Pre-DAA FIB-4 does not increase prediction value for de novo liver complications in hepatitis C

Chun-Ming Hong; Tung-Hung Su; Shih-Jer Hsu; Tai-Chung Tseng; Chen-Hua Liu; Hung-Chih Yang; Jia-Horng Kao; Pei-Jer Chen; Pin-Nan Cheng; Chao-Hung Hung; Cheng-Yuan Peng; Chien-Hung Chen; Chun-Yen Lin; Hsing-Tao Kuo; Han-Chieh Lin; Yi-Hsiang Huang; Chi-Yi Chen; Chih-Lin Lin; Pei-Chien Tsai; Yu-Syuan Zeng; Chia-Yen Dai; Wan-Long Chuang; Jee-Fu Huang; Chung-Feng Huang; Ming-Lun Yeh; Ming-Lung Yu; Chun-Jen Liu

doi:10.1016/j.jfma.2024.10.024

Addition of neutrophil-to-lymphocyte ratio to Pre-DAA FIB-4 does not increase prediction value for de novo liver complications in hepatitis C

J Formos Med Assoc. 2024 Nov 1:S0929-6646(24)00511-4. doi: 10.1016/j.jfma.2024.10.024. Online ahead of print.

Authors

Chun-Ming Hong¹, Tung-Hung Su², Shih-Jer Hsu², Tai-Chung Tseng³, Chen-Hua Liu², Hung-Chih Yang², Jia-Horng Kao⁴, Pei-Jer Chen⁴, Pin-Nan Cheng⁵, Chao-Hung Hung⁶, Cheng-Yuan Peng⁷, Chien-Hung Chen⁸, Chun-Yen Lin⁹, Hsing-Tao Kuo¹⁰, Han-Chieh Lin¹¹, Yi-Hsiang Huang¹¹, Chi-Yi Chen¹², Chih-Lin Lin¹³, Pei-Chien Tsai¹⁴, Yu-Syuan Zeng¹⁴, Chia-Yen Dai¹⁴, Wan-Long Chuang¹⁴, Jee-Fu Huang¹⁴, Chung-Feng Huang¹⁴, Ming-Lun Yeh¹⁴, Ming-Lung Yu¹⁴, Chun-Jen Liu¹⁵

Affiliations

¹ Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Medicine Research, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
⁶ Division of Hepatogastroenterology, Department of Internal Medicine, ChiaYi Chang Gung Memorial Hospital, Taiwan; Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
⁷ Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan.
⁸ Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
⁹ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Taiwan.
¹¹ Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹² Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan.
¹³ Department of Gastroenterology, Renai Branch, Taipei City Hospital, Taipei, Taiwan.
¹⁴ Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹⁵ Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: [email protected].

PMID: 39488497
DOI: 10.1016/j.jfma.2024.10.024

Abstract

Background and aims: Direct-acting antiviral agents (DAAs) achieve high sustained virologic response (SVR) in chronic hepatitis C patients; yet a proportion of patients still experience de novo liver complications after SVR. Identification of risk factors is clinically important. FIB-4 index is a useful noninvasive tool to assess fibrosis, while neutrophil-to-lymphocyte ratio (NLR) is a biomarker for systemic inflammation. Our study aimed to investigate whether the addition of NLR can increase the prediction power of pre-DAA FIB-4 for de novo liver complications after SVR.

Methods: We recruited patients via The Taiwan HCV Registry (TACR) and National Health Insurance Registry Database. The inclusion criteria were patients who achieved SVR12 after DAA and were followed for at least 24 months after SVR12. Liver complications included ascites, hepatic encephalopathy, variceal bleeding, and HCC.

Results: Totally 7657 patients were recruited from 2013 to 2018. Among them, 3674 patients (48.0%) had a FIB-4 value > 3.25 and 491 patients (6.4%) had a NLR >4 before DAA. After two-year of follow-up after SVR 12, 214 patients (2.8%) developed de novo liver complications. Factors associated with liver complications included male gender, diabetes mellitus, hyperlipidemia, chronic kidney disease, and pre-DAA FIB-4 >3.25 in multivariate analyses. Addition of NLR slightly did not increase the power of predicting liver complications.

Conclusions: The overall incidence of de novo liver complications after SVR is low during short-term follow-up. Elevated pre-DAA FIB-4 is associated with de novo liver complications after SVR, whereas the addition of pre-DAA NLR does not increase the prediction power.

Keywords: Chronic hepatitis C; Direct-acting antiviral agent; de novo liver complication.