Abstract：
BACKGROUND: Patients treated with direct-acting antivirals for hepatitis C exhibit high cure rates and improved survival. However, there is limited knowledge on their long-term clinical evolution.
OBJECTIVE: In this study, we aimed to analyse the risk of hepatocarcinoma and hepatic decompensation in patients treated with direct-acting antivirals.
METHODS: We conducted a retrospective single-centre study of Portuguese patients with advanced fibrosis treated with direct-acting antiviral agents between 2015 and 2022 at a tertiary hospital.
RESULTS: Out of 460 patients, 50 (10.9 %) developed hepatocarcinoma and 36 (7.8 %) experienced hepatic decompensation. The risk for hepatocarcinoma was higher in patients aged over 55 (HR 4.87, 95 % CI 2.34-10.13, p < 0.001), with signs of portal hypertension (HR 3.83, 95 % CI 2.05-7.13, p < 0.001) and arterial hypertension (HR 1.98, 95 % CI 1.09-3.58, p = 0.024). Alcohol consumption (HR 3.30, 95 % CI 1.22-8.94, p = 0.019), signs of portal hypertension (HR 4.56, 95 % CI 2.19-9.48, p < 0.001) and hepatocarcinoma (HR 3.47, 95 % CI 1.69-7.10, p < 0.001) increased the risk of hepatic decompensation.
CONCLUSIONS: Our study found a high incidence of hepatocarcinoma and hepatic decompensation, along with high mortality, in patients with advanced fibrosis treated with direct-acting antivirals. We identified risk factors such as arterial hypertension, alcohol consumption, and signs of portal hypertension, highlighting their role in clinical management and patient monitoring.
OBJECTIVE: In this study, we aimed to analyse the risk of hepatocarcinoma and hepatic decompensation in patients treated with direct-acting antivirals.
METHODS: We conducted a retrospective single-centre study of Portuguese patients with advanced fibrosis treated with direct-acting antiviral agents between 2015 and 2022 at a tertiary hospital.
RESULTS: Out of 460 patients, 50 (10.9 %) developed hepatocarcinoma and 36 (7.8 %) experienced hepatic decompensation. The risk for hepatocarcinoma was higher in patients aged over 55 (HR 4.87, 95 % CI 2.34-10.13, p < 0.001), with signs of portal hypertension (HR 3.83, 95 % CI 2.05-7.13, p < 0.001) and arterial hypertension (HR 1.98, 95 % CI 1.09-3.58, p = 0.024). Alcohol consumption (HR 3.30, 95 % CI 1.22-8.94, p = 0.019), signs of portal hypertension (HR 4.56, 95 % CI 2.19-9.48, p < 0.001) and hepatocarcinoma (HR 3.47, 95 % CI 1.69-7.10, p < 0.001) increased the risk of hepatic decompensation.
CONCLUSIONS: Our study found a high incidence of hepatocarcinoma and hepatic decompensation, along with high mortality, in patients with advanced fibrosis treated with direct-acting antivirals. We identified risk factors such as arterial hypertension, alcohol consumption, and signs of portal hypertension, highlighting their role in clinical management and patient monitoring.
摘要：
背景：使用直接抗病毒药物治疗丙型肝炎的患者具有较高的治愈率和改善的生存率。然而,对其长期临床演变的了解有限。
目的：在本研究中，我们旨在分析直接抗病毒药物治疗患者肝癌和肝脏失代偿的风险。
方法：我们在2015年至2022年间在三级医院对葡萄牙晚期纤维化患者进行了回顾性单中心研究。
结果：在460名患者中，50例（10.9％）发生肝癌，36例（7.8％）发生肝失代偿。55岁以上患者患肝癌的风险较高(HR4.87,95%CI2.34-10.13,p<0.001),伴有门静脉高压症（HR3.83，95％CI2.05-7.13，p<0.001）和动脉高压症（HR1.98，95％CI1.09-3.58，p=0.024）。饮酒（HR3.30，95%CI1.22-8.94，p=0.019），门静脉高压症（HR4.56，95％CI2.19-9.48，p<0.001）和肝癌（HR3.47，95％CI1.69-7.10，p<0.001）的体征增加了肝功能失代偿的风险。
结论：我们的研究发现肝癌和肝脏失代偿的发生率很高，伴随着高死亡率，在接受直接作用抗病毒药物治疗的晚期纤维化患者中。我们确定了动脉高血压等危险因素，酒精消费,和门静脉高压症的迹象，强调其在临床管理和患者监测中的作用。
目的：在本研究中，我们旨在分析直接抗病毒药物治疗患者肝癌和肝脏失代偿的风险。
方法：我们在2015年至2022年间在三级医院对葡萄牙晚期纤维化患者进行了回顾性单中心研究。
结果：在460名患者中，50例（10.9％）发生肝癌，36例（7.8％）发生肝失代偿。55岁以上患者患肝癌的风险较高(HR4.87,95%CI2.34-10.13,p<0.001),伴有门静脉高压症（HR3.83，95％CI2.05-7.13，p<0.001）和动脉高压症（HR1.98，95％CI1.09-3.58，p=0.024）。饮酒（HR3.30，95%CI1.22-8.94，p=0.019），门静脉高压症（HR4.56，95％CI2.19-9.48，p<0.001）和肝癌（HR3.47，95％CI1.69-7.10，p<0.001）的体征增加了肝功能失代偿的风险。
结论：我们的研究发现肝癌和肝脏失代偿的发生率很高，伴随着高死亡率，在接受直接作用抗病毒药物治疗的晚期纤维化患者中。我们确定了动脉高血压等危险因素，酒精消费,和门静脉高压症的迹象，强调其在临床管理和患者监测中的作用。
