LAUSR

BACKGROUND & AIMS We aimed to investigate the factors associated with improvement of liver functional reserve after sustained virologic response using interferon-free, direct-acting antiviral combination treatment in patients with compensated, severe fibrosis. METHODS Between September 2014 and April 2020, 492 patients received direct-acting antiviral combination treatment in our hospital. Among them, 173 patients who had severe fibrosis based on a Fibrosis-4 index ≥ 3.25, showed sustained virologic response after treatment. We investigated the dynamic change in Albumin-Bilirubin score and the baseline factors associated with its improvement, 48 weeks after treatment. RESULTS The baseline significant factors associated with ΔAlbumin-Bilirubin ≦ -0.5 were lower albumin (HR: 15.625, 95% CI: 4.273-58.824, P < 0.001), higher hepatitis C virus RNA (HR: 4.995, 95% CI: 1.882-13.260, P = 0.001), and higher alpha-fetoprotein (HR: 1.033, 95% CI: 1.011-1.055, P = 0.003). Patients with alpha-fetoprotein ≧10 ng/mL showed significant improvement of Albumin-Bilirubin score from baseline to 48 weeks after treatment compared to those with alpha-fetoprotein < 10 ng/mL (P < 0.001). CONCLUSIONS Baseline serum alpha-fetoprotein might be a predictive factor for improvement of liver function after sustained virologic response in patients with severe fibrosis.