IDDF2024-ABS-0174 Prognostic significance of dynamic changes in liver stiffness measurement in patients with chronic hepatitis B and compensated advanced chronic liver disease

<h3>Background</h3> Liver stiffness measurement (LSM) holds promise in monitoring disease progression or regression. We aim to assess the prognostic significance of the dynamic changes in LSM over time concerning liver-related events (LREs) and death in patients with chronic hepatitis B (CHB) and compensated advanced chronic liver disease (cACLD). <h3>Methods</h3> This retrospective study included 1272 patients with CHB and cACLD who underwent at least twice measurement, including LSM and fibrosis score based on four factors (FIB-4) (IDDF2024-ABS-0174 Figure 1). ΔLSM was calculated as [(follow-up LSM-baseline LSM)/baseline LSM×100], expressed as a percentage. All the participants received antiviral treatment for at least 6 months. We recorded LREs and all-cause mortality during a median follow-up time of 46 months. Hazard ratios (HR) and confidence interval (CI) for outcomes were calculated using Cox regression. Individuals were stratified into different risk groups based on baseline LSM and Δ LSM (low risk, baseline LSM ≤ 15kpa + Δ LSM &lt; -20%; intermediate risk, baseline LSM &gt; 15kpa + Δ LSM &lt; -20%; high risk, baseline LSM ≤ 15kpa + Δ LSM ≥ -20%; extremely high risk, baseline LSM &gt; 15kpa + Δ LSM ≥ -20%). <h3>Results</h3> Baseline FIB-4, baseline LSM, ΔFIB-4, and ΔLSM were independently and simultaneously associated with LREs (adjusted HR, 1.04, 95% CI, 1.00-1.07; 1.02, 95% CI, 1.01-1.03; 1.06, 95% CI, 1.03-1.09; 2.05, 95% CI, 1.71-2.46, respectively). Baseline LSM combined with ΔLSM achieved the highest Harrell’s C (0.751), integrated AUC (0.776), and time-dependent AUC (0.737) for LREs. By using baseline LSM and ΔLSM, we proposed a risk stratification method to improve clinical applications. The risk stratification proposed based on LSM performed well in terms of prognosis: low risk (n=390; reference), intermediate risk (n=446; HR=3.38), high risk (n=272; HR=5.64), extremely high risk (n=164; HR=11.11) (IDDF2024-ABS-0174 Figure 1). <h3>Conclusions</h3> Baseline and repeated non-invasive test measurements allow individual risk stratification of patients with CHB and cACLD. Combining baseline and dynamic changes in LSM improves prognostic prediction.