Backgound&aims: The Baveno VII consensus introduced the term "recompensated cirrhosis," though few studies have examined its clinical relevance. We analyzed the rate and predictors of recompensation in hepatitis C (HCV) patients after sustained virological response (SVR) and evaluated its impact on mortality and hepatocellular carcinoma (HCC) compared to compensated and decompensated cirrhosis.
Methods: Multicenter observational study enrolling 916 HCV-related cirrhotic patients, with a minimum follow-up period of 12 months after SVR. Subjects were categorized into three mutually exclusive groups: compensated, decompensated, and recompensated group. Patients were followed until the occurrence of liver transplantation, death, or the last follow-up date, whichever came first.
Results: During the study (4.5±2.5 years), 12% (110/916) experienced a decompensating event, 7.7% (71/916) were diagnosed with HCC, and 14.9% (137/916) died. Among 23% (216/916) patients who were decompensated at baseline, 63.4% (137/216) achieved recompensation at 12 months. Child-Pugh score [OR 0.69 (95% CI 0.53-0.89); p=0.005] and the number of past decompensating events were associated with recompensation. The compensated cohort exhibited a lower mortality rate (4.2% (28/663)) than recompensated (36.5% (50/137)), and decompensated subjects (50% (30/60)) (p=0.0001). Along with age [CSHR 1.03 (95% CI 1.01-1.05); p=0.0009], albumin [CSHR 0.67 (95% CI 0.45-0.98); p=0.038], INR, [CSHR 1.88 (95% CI 1.14-3.10); p=0.014], bilirubin levels [CSHR 1.28 (95% CI 1.08-1.50);p=0.003], recompensated [CSHR 0.30 (95% CI 0.19-0.49); p=0.0001] and compensated states [CSHR 0.09 (95% CI 0.05-0.16); p=0.0001] were associated with mortality. By contrast, HCC occurrence was significantly lower in compensated (4.4% (29/662)) than recompensated (14.4% (19/132)), and decompensated patients (12.1% (7/58)) (p=0.0001).
Conclusions: Two-thirds of patients with decompensated cirrhosis achieved recompensation twelve months post-SVR, leading to improved survival compared to those without recompensation, though still lower than in compensated patients. However, HCC risk remained unchanged in the recompensated cohort.
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