Fibrosis-4 Index Value Before Direct-Acting Antiviral Therapy as a Predictor of Esophageal Varices Progression After Sustained Virologic Response at 12 Weeks with Direct-Acting Antiviral Therapy

Abstract

Background and Objective: The objectives of this study were to assess the effect that direct-acting
antivirals (DAAs) have on portal hypertension once a sustained viral response (SVR) has been achieved.
Therefore, it is important to look at economical and noninvasive predictors. We looked into the factors that
contributed to the emergence of EVs in hepatitis C infected patients after SVR with DAAs.
Methods: It was an Open-Label Single-Arm clinical trial conducted at department of Gastroenterology,
AIMC/Jinnah Hospital, Lahore during the period of 3 years and 4 months ( from June 2017 to October 2020).
Total of 99 patients who attained SVR post DAA therapy were enrolled in this study and their pre- and post-
treatment esophagogastroduodenoscopy (EGD) findings were compared. EV progression and non-
progression were assessed. Additionally. EV cumulative advancement rates were examined.
Results: Before DAA treatment, the fibrosis-4 index (FIB-4) was the only substantial predictor of EVs
progression after SVR ( 95% confidence intervals: 1.25-1.54. odds ratios: 1.45, p = 0.02). Based on ROC
curve analysis, patients with a FIB-4 of 8.5 or higher had a higher risk of EVs (sensitivity =0.69, specificity =
0.91, positive predictive value = 0.36, negative predictive value=0.98).
Conclusion: CEV development is possible in patients with FIB-42 8.5, so EGD surveillance should continue
after SVR.