Table 3.
Association between SVR and Resolution of Hepatic Encephalopathy
| Number of patients (%) | Mean Follow-up (Years) | Number with HE resolution (%) | HE resolution per 100 patient-years | Crude hazard ratio (95% CI) | Adjusted* hazard ratio (95%CI) | ||
|---|---|---|---|---|---|---|---|
| IFN-ONLY regimens | No SVR | 811(82.4) | 4.8 | 289(35.6) | 7.47 | 1 | 1 |
| SVR | 173(17.6) | 4.1 | 113(65.3) | 15.76 | 2.08(1.62–2.68) | 2.10(1.57–2.82) | |
| DAA+IFN regimens | No SVR | 114(57.6) | 2.4 | 24(21.1) | 8.68 | 1 | 1 |
| SVR | 84(42.4) | 3.0 | 41(48.8) | 16.27 | 1.88(1.12–3.16) | 1.39(0.60–3.18) | |
| DAA-only regimens | No SVR | 366(22.4) | 1.9 | 63(17.2) | 9 | 1 | 1 |
| SVR | 1,267(77.6) | 2.4 | 432(34.1) | 14.26 | 1.59(1.21–2.09) | 1.39(1.03–1.87) | |
| MELD < 9 | No SVR | 768(51.1) | 4.4 | 253(32.9) | 7.56 | 1 | 1 |
| SVR | 734(48.9) | 2.7 | 357(48.6) | 17.99 | 2.27(1.89–2.72) | 2.26(1.74–2.93) | |
| MELD ≥ 9 | No SVR | 670(42.7) | 3.2 | 164(24.5) | 7.66 | 1 | 1 |
| SVR | 898(57.3) | 2.6 | 274(30.5) | 11.74 | 1.49(1.20–1.84) | 1.16(0.84–1.60) | |
| DAA-only MELD < 9 | No SVR | 120(20.1) | 2.1 | 21(17.5) | 8.18 | 1 | 1 |
| SVR | 476(79.9) | 2.3 | 212(44.5) | 19.27 | 2.35(1.49–3.70) | 2.20(1.36–3.57) | |
| DAA-only MELD ≥ 9 | No SVR | 224(23.7) | 1.8 | 40(17.9) | 10.02 | 1 | 1 |
| SVR | 722(76.3) | 2.4 | 199(27.6) | 11.34 | 1.13(0.79–1.61) | 0.98(0.66–1.45) | |
| Diabetes | No SVR | 410(41.7) | 3.5 | 115(28.0) | 8 | 1 | 1 |
| SVR | 574(58.3) | 2.5 | 208(36.2) | 14.71 | 1.80(1.39–2.34) | 1.95(1.27–2.97) | |
| No diabetes | No SVR | 881(48.1) | 3.9 | 261(29.6) | 7.66 | 1 | 1 |
| SVR | 950(51.9) | 2.7 | 378(39.8) | 14.63 | 1.86(1.56–2.22) | 1.75(1.37–2.24) | |
| Alcohol use disorder | No SVR | 654(43.2) | 3.6 | 186(28.4) | 8 | 1 | 1 |
| SVR | 859(56.8) | 2.6 | 297(34.6) | 13.28 | 1.63(1.33–2.00) | 1.43(1.08–1.90) | |
| No Alcohol use disorder | No SVR | 637(48.9) | 4.0 | 190(29.8) | 7.54 | 1 | 1 |
| SVR | 665(51.1) | 2.6 | 289(43.5) | 16.4 | 2.10(1.71–2.58) | 2.29(1.71–3.06) | |
| Pre 2009 | No SVR | 631(85.0) | 5.2 | 232(36.8) | 7.11 | 1 | 1 |
| SVR | 111(15.0) | 4.5 | 71(64.0) | 14.14 | 1.95(1.43–2.65) | 2.17(1.49–3.15) | |
| 2009–2015 | No SVR | 660(31.8) | 2.4 | 144(21.8) | 9.09 | 1 | 1 |
| SVR | 1,413(68.2) | 2.5 | 515(36.4) | 14.73 | 1.59(1.30–1.94) | 1.71(1.38–2.12) | |
| Men | No SVR | 1,253(46.0) | 3.7 | 364(29.1) | 7.8 | 1 | 1 |
| SVR | 1,470(54.0) | 2.6 | 568(38.6) | 14.81 | 1.85(1.59–2.14) | 2.06(1.73–2.46) | |
| Women | No SVR | 39(41.9) | 4.7 | 13(33.3) | 7.02 | 1 | 1 |
| SVR | 54(58.1) | 3.0 | 18(33.3) | 11 | 1.80(0.85–3.82) | 11.3(0.78–164.5) | |
| Ascites ± varices ± HRS | No SVR | 447(40.2) | 2.7 | 79(17.7) | 6.43 | 1 | 1 |
| SVR | 665(59.8) | 2.5 | 188(28.3) | 11.28 | 1.75(1.32–2.32) | 1.82(1.18–2.80) | |
| All Regimens, lactulose or rifaximin, but not neomycin | No SVR | 1,268(45.5) | 3.8 | 7.77 | 1 | 1 | |
| SVR | 1,521(54.5) | 2.6 | 585(38.5) | 14.65 | 1.84(1.59–2.13) | 1.78(1.44–2.20) | |
| All Regimens, lactulose | No SVR | 1,044(51.6) | 4.1 | 8.1 | 1 | 1 | |
| SVR | 980(48.4) | 2.6 | 467(47.7) | 18.09 | 2.13(1.82–2.49) | 1.84(1.47–2.29) | |
| All Regimens, rifamixin |
No SVR | 51(27.1) | 2.1 | 8(15.7) | 7.5 | 1 | 1 |
| SVR | 137(72.9) | 2.3 | 59(43.1) | 18.89 | 2.57 (1.14–5.78) | 1.85 (0.44–7.85) |
*
Adjusted for regimen type, cirrhosis, decompensated cirrhosis, age, sex, race/ethnicity, body mass index, HBV co-infection, type 2 diabetes mellitus, ascites, varices, hepatocellular carcinoma, alcohol use disorders, substance use disorder, platelet count, serum bilirubin, serum creatinine, serum albumin, INR and blood hemoglobin levels. The laboratory tests were categorized into quartiles and modeled as dummy categorical variables. †Portal hypertension is defined by the presence of varices or ascites. DAA = direct acting antivirals, HRS = hepatorenal syndrome, IFN = interferon, MELD = model for endstage liver disease, SVR = sustained virologic response