Background and aims: People living with HIV (PLWH) are at high risk for advanced chronic liver disease and related adverse outcomes. We aimed to validate the prognostic value of non-invasive scores based on liver stiffness measurement (LSM) and on markers of portal hypertension (PH), namely platelets and spleen diameter, in PLWH. Methods: We combined data from eight international cohorts of PLWH with available non-invasive scores, including LSM and the composite biomarkers liver stiffness-spleen size-to-platelet ratio score (LSPS), LSM-to-Platelet ratio (LPR) and PH risk score. Incidence and predictors of all-cause mortality, any liver-related event and classical hepatic decompensation were determined by survival analysis, controlling for competing risks for the latter two. Non-invasive scores were assessed and compared using area under the receiver operating curve (AUROC). Results: We included 1695 PLWH (66.8% coinfected with hepatitis C virus). During a median follow-up of 4.7 (interquartile range 2.8-7.7) years, the incidence rates of any liver-related event, all-cause mortality and hepatic decompensation were 13.7 per 1000 persons-year (PY) (95% confidence interval [CI], 11.4-16.3), 13.8 per 1000 PY (95% CI, 11.6-16.4) and 9.9 per 1000 PY (95% CI, 8.1-12.2), respectively. The AUROC of LSM was similar to that of the composite biomarkers, ranging between 0.83 and 0.86 for any liver-related event, 0.79-0.85 for all-cause mortality and 0.87-0.88 for classical hepatic decompensation. All individual non-invasive scores remained independent predictors of clinical outcomes in multivariable analysis. Conclusions: Non-invasive scores based on LSM, spleen diameter and platelets predict clinical outcomes in PLWH. Composite biomarkers do not achieve higher prognostic performance compared to LSM alone.

Prognostic value of non-invasive scores based on liver stiffness measurement, spleen diameter and platelets in HIV-infected patients / Benmassaoud, Amine; Macias, Juan; Delamarre, Adèle; Corma-Gomez, Anaïs; Guaraldi, Giovanni; Milic, Jovana; Rockstroh, Jürgen K; Van Bremen, Kathrin; Tsochatzis, Emmanuel; Mulay, Akhilesh; Price, Jennifer; Garvey, Lucy J; Lemoine, Maud; Kablawi, Dana; Lebouche, Bertrand; Klein, Marina B; Ballesteros, Luz R; Boesecke, Christopher; Schepis, Filippo; Bhagani, Sanjay; Cooke, Graham; Berzigotti, Annalisa; Hirose, Kyoko; Pineda, Juan A; Ramanakumar, Agnihotram V; De-Ledinghen, Victor; Saeed, Sahar; Sebastiani, Giada. - In: LIVER INTERNATIONAL. - ISSN 1478-3231. - 43:7(2023), pp. 1427-1439. [10.1111/liv.15605]

Prognostic value of non-invasive scores based on liver stiffness measurement, spleen diameter and platelets in HIV-infected patients

Guaraldi, Giovanni;Schepis, Filippo;
2023

Abstract

Background and aims: People living with HIV (PLWH) are at high risk for advanced chronic liver disease and related adverse outcomes. We aimed to validate the prognostic value of non-invasive scores based on liver stiffness measurement (LSM) and on markers of portal hypertension (PH), namely platelets and spleen diameter, in PLWH. Methods: We combined data from eight international cohorts of PLWH with available non-invasive scores, including LSM and the composite biomarkers liver stiffness-spleen size-to-platelet ratio score (LSPS), LSM-to-Platelet ratio (LPR) and PH risk score. Incidence and predictors of all-cause mortality, any liver-related event and classical hepatic decompensation were determined by survival analysis, controlling for competing risks for the latter two. Non-invasive scores were assessed and compared using area under the receiver operating curve (AUROC). Results: We included 1695 PLWH (66.8% coinfected with hepatitis C virus). During a median follow-up of 4.7 (interquartile range 2.8-7.7) years, the incidence rates of any liver-related event, all-cause mortality and hepatic decompensation were 13.7 per 1000 persons-year (PY) (95% confidence interval [CI], 11.4-16.3), 13.8 per 1000 PY (95% CI, 11.6-16.4) and 9.9 per 1000 PY (95% CI, 8.1-12.2), respectively. The AUROC of LSM was similar to that of the composite biomarkers, ranging between 0.83 and 0.86 for any liver-related event, 0.79-0.85 for all-cause mortality and 0.87-0.88 for classical hepatic decompensation. All individual non-invasive scores remained independent predictors of clinical outcomes in multivariable analysis. Conclusions: Non-invasive scores based on LSM, spleen diameter and platelets predict clinical outcomes in PLWH. Composite biomarkers do not achieve higher prognostic performance compared to LSM alone.
2023
43
7
1427
1439
Prognostic value of non-invasive scores based on liver stiffness measurement, spleen diameter and platelets in HIV-infected patients / Benmassaoud, Amine; Macias, Juan; Delamarre, Adèle; Corma-Gomez, Anaïs; Guaraldi, Giovanni; Milic, Jovana; Rockstroh, Jürgen K; Van Bremen, Kathrin; Tsochatzis, Emmanuel; Mulay, Akhilesh; Price, Jennifer; Garvey, Lucy J; Lemoine, Maud; Kablawi, Dana; Lebouche, Bertrand; Klein, Marina B; Ballesteros, Luz R; Boesecke, Christopher; Schepis, Filippo; Bhagani, Sanjay; Cooke, Graham; Berzigotti, Annalisa; Hirose, Kyoko; Pineda, Juan A; Ramanakumar, Agnihotram V; De-Ledinghen, Victor; Saeed, Sahar; Sebastiani, Giada. - In: LIVER INTERNATIONAL. - ISSN 1478-3231. - 43:7(2023), pp. 1427-1439. [10.1111/liv.15605]
Benmassaoud, Amine; Macias, Juan; Delamarre, Adèle; Corma-Gomez, Anaïs; Guaraldi, Giovanni; Milic, Jovana; Rockstroh, Jürgen K; Van Bremen, Kathrin; T...espandi
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