Z Gastroenterol 2019; 57(09): e275-e276
DOI: 10.1055/s-0039-1695341
Leber und Galle
Hepatitis C: Donnerstag, 03. Oktober 2019, 08:00 – 09:36, Studio Terrasse 2.1 B
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Baseline risk factors determine lack of biochemical response after SVR in chronic hepatitis C treated with DAAs – Results from the German Hepatitis C-Registry (DHC-R)

S Mauss
1   Center for HIV and Hepatogastroenterology, Düsseldorf, Deutschland
,
KH Böker
2   Hepatologische Praxis, Hannover, Deutschland
,
H Klinker
3   Universitätsklinikum Würzburg, Würzburg, Deutschland
,
R Heyne
4   Leberzentrum am Checkpoint, Berlin, Deutschland
,
P Buggisch
5   ifi – Institut für Interdisziplinäre Medizin, Hamburg, Deutschland
,
A Pathil
6   Universitätsklinikum Heidelberg, Heidelberg, Deutschland
,
J Wiegand
7   Universitätsklinikum Leipzig, Leipzig, Deutschland
,
M Cornberg
8   Medizinische Hochschule Hannover, Hannover, Deutschland
,
C Lange
9   Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
,
T Berg
7   Universitätsklinikum Leipzig, Leipzig, Deutschland
,
S Zeuzem
10   Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
,
F Tacke
11   Universitätsklinikum Aachen, Aachen, Deutschland
12   Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
D Hepatitis CRegister
13   Leberstiftungs-GmbH Deutschland, Hannover, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2019 (online)

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    Background and aims:

    Elevated liver function tests (ALT, GGT) in chronic hepatitis C not always normalize after successful elimination of HCV by DAAs, indicating concomitant additional liver diseases. We analysed the factors determining biochemical response (normal ALT or GGT) of DAA therapy in a large real-world cohort, the German Hepatitis C-Registry.

    Method:

    Normal ALT (at 37 °C) was defined as (i) ≤35 U/l for females and ≤50 U/l for males and or (ii) according to AASLD as ≤19 U/l for females and ≤30 U/l for males. Normal GGT (at 37 °C) was defined as ≤40 U/l ♀ and ≤60 U/l ♂. Statistical analysis was performed using univariate and multivariate logistic regression analyses (including HCV-related factors, patient characteristics, comorbidities).

    Results:

    At baseline, we found elevated ALT in 3705/4946 (74.9%), elevated ALT (AASLD) in 4669/4946 (94.4%) and elevated GGT in 3018/4906 (61.5%). 97% of patients achieved SVR12. At week 12 after end of therapy, we found elevated ALT in 451/4946 (9.1%) or ALT (AASLD) in 1906/4946 (38.5%) and GGT in 863/4879 (17.7%). Elevated ALT at baseline was associated with HCV GT1 compared to GT3 (OR 2.42), male sex (OR 1.68), higher BMI class (OR 2.04, 3.44, 3.25), liver cirrhosis (OR 1.90), being on OST (OR 0.47), being German vs. European or Russian (OR 1.46, 1.36). With the stricter ALT AASLD definition, liver cirrhosis and being of Russian origin dropped out and GT2 had a higher risk (OR 1.98). Higher GGT at baseline was associated with HCV GT3 and 2 compared to GT1 (OR 2.52, 1.37), higher BMI category (OR 1.84, 2.28), age > 50 years (OR 1.28) and liver cirrhosis (OR 3.22). At week 12 after end of therapy, elevated ALT was associated with high BMI (OR 0.33), age < 70 years (OR 0.67), liver cirrhosis (OR 2.25), diabetes mellitus (OR 1.49), alcohol consumption (OR 2.43) and non-SVR12 (OR 0.04). Higher GGT at week 12 was associated with age > 70 years (OR 1.42), liver cirrhosis (OR 3.97), alcohol consumption (OR 4.61) and non-SVR (OR 0.15).

    Conclusion:

    Risk factors already present at baseline like obesity, liver cirrhosis and alcohol consumption are associated with elevated liver function tests after SVR, indicating that these patients have additional hepatic morbidities and warrant further hepatological follow-up.


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