Addition of neutrophil-to-lymphocyte ratio to Pre-DAA FIB-4 does not increase prediction value for de novo liver complications in hepatitis C.
Journal
Journal of the Formosan Medical Association
Journal Volume
124
Journal Issue
12
Start Page
1149
End Page
1156
ISSN
0929-6646
Date Issued
2025-12
Author(s)
Cheng, Pin-Nan
Hung, Chao-Hung
Peng, Cheng-Yuan
Lin, Chun-Yen
Kuo, Hsing-Tao
Lin, Han-Chieh
Huang, Yi-Hsiang
Chen, Chi-Yi
Lin, Chih-Lin
Tsai, Pei-Chien
Zeng, Yu-Syuan
Dai, Chia-Yen
Chuang, Wan-Long
Huang, Jee-Fu
Huang, Chung-Feng
Yeh, Ming-Lun
Yu, Ming-Lung
Abstract
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.
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.
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.
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.
Subjects
Chronic hepatitis C
Direct-acting antiviral agent
de novo liver complication
SDGs
Type
journal article