CONTROLLED attenuation parameter dynamics independently predicted liver-related events in patients with chronic hepatitis B receiving antiviral therapy, suggesting that longitudinal monitoring may provide additional prognostic information. The association persisted after accounting for changes in liver stiffness measurements.
The study included 573 patients with chronic hepatitis B (CHB) who had significant fibrosis or cirrhosis before starting antiviral therapy. Hepatic steatosis was assessed using the controlled attenuation parameter (CAP), while liver-related events included hepatic decompensation, hepatocellular carcinoma, liver transplantation, or liver-related death.
Patients were followed for a median of 6.9 years, during which 51 liver-related events occurred. Joint models were used to examine associations between longitudinal measurements and subsequent event risk.
Dynamic changes in CAP independently predicted liver-related events. Each 10 dB/m increase in CAP was associated with a lower risk of these outcomes (adjusted hazard ratio [aHR]: 0.86; 95% CI: 0.78–0.96; p=0.006).
The association remained after adjustment for liver stiffness measurement (LSM) dynamics (aHR per 10 dB/m CAP increase: 0.85; 95% CI: 0.77–0.95; p=0.005).
CAP measurements exceeding 236 dB/m over time were also associated with a reduced risk of liver-related events (aHR: 0.67; 95% CI: 0.53–0.84; p<0.001).
Combining longitudinal CAP and LSM measurements improved prediction compared with LSM dynamics alone. The 7-year area under the receiver operating characteristic curve increased from 0.70 with LSM alone to 0.75 when CAP and LSM dynamics were integrated.
The findings demonstrate an association between longitudinal CAP changes and liver-related event risk among patients with CHB and significant fibrosis receiving antiviral therapy. They also indicate that monitoring CAP over time could provide prognostic information beyond liver stiffness dynamics alone.
Longitudinal CAP assessment may therefore offer additional value for evaluating liver-related risk during antiviral treatment in this population.
Reference
Ai X et al. Dynamic changes in controlled attenuation parameter (CAP) improve prognostic prediction for CHB patients with significant fibrosis and cirrhosis. Hep Intl. 2026. https://doi.org/10.1007/s12072-026-11145-w
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