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Investigators formulated a five-factor metric known as the BE3A score that offers specialists a shared decision-making tool to predict potential improvements after treatment in patients with hepatitis C virus (HCV)-associated liver failure, as detailed in a new study published in Gastroenterology.
The five factors in the BE3A score include body mass index (BMI), encephalopathy, ascites, and serum levels of both alanine aminotransferase (ALT) and albumin.
“HCV infection can be successfully treated in patients with decompensated cirrhosis with direct acting antiviral therapy (DAA), but treatments do not always improve symptoms of decompensation or alter the course of liver failure,” wrote co-first author Z. Gordon Jiang, MD, PhD, Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, and coauthors.
Although previous clinical trials have indicated that viral eradication using DAAs in HCV patients with decompensated cirrhosis results in improved Model for End-Stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) scores, this improvement may not be linked to clinical or transplantation-free survival benefits in these patients.
“The term MELD purgatory has been used to describe some patients who experience viral eradication, have an improvement in the biochemical parameters of the MELD score, yet remain decompensated post-treatment,” the authors wrote.
The investigators stressed the importance of discovering the “point of no return,” which is the degree of liver dysfunction at which conventional HCV treatment no longer provides a benefit.
“Pretreatment predictors of benefit are needed to guide patient selection for therapy and, more importantly, identify a group of patients in whom therapy is futile and who should undergo liver transplantation and DAA therapy post-transplantation,” Dr. Jiang and coauthors wrote.
To devise the BE3A score to predict clinical improvement, they identified five of these factors with the highest associations:
- BMI < 25
- no Encephalopathy
- no Ascites
- ALT > 60 IU/L
- Albumin > 3.5 g/dL
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