Comparison of FAST Score and Liver Stiffness for Predicting Liver Complications Post-HCV Cure

Overview

This multicenter cohort study compared the predictive ability of liver stiffness (LS) and the FibroScan-AST (FAST) score for liver complications after sustained virological response (SVR) in patients with hepatitis C virus (HCV) infection. Both LS and FAST independently predicted liver events, but FAST did not significantly improve prediction over LS alone.

Background

Hepatitis C virus (HCV) infection is now curable with direct-acting antivirals (DAAs), yet patients with advanced liver disease remain at risk for liver complications after achieving sustained virological response (SVR). Liver stiffness (LS) measured by transient elastography is a strong predictor of such outcomes but has limited positive predictive value. The FAST score, combining LS, aspartate aminotransferase (AST), and controlled attenuation parameter (CAP), reflects steatohepatitis and may better predict liver-related events, especially in patients with concomitant steatotic liver disease (SLD), which is common in HCV-infected individuals.

Data Highlights

Key Findings

• Liver stiffness (LS) measured at SVR independently predicts liver complications including decompensation and hepatocellular carcinoma (HCC) in patients with advanced fibrosis.
• The FAST score, incorporating LS, AST, and CAP, also independently predicts liver complications with a strong association (sHR 8.12 for FAST ≥0.35).
• The predictive accuracy (AUROC) of LS alone (0.83) was slightly higher than that of FAST (0.80), but the difference was not statistically significant (P = .158).
• 44% of patients had fatty liver disease (CAP ≥248 dB/m) at SVR, highlighting the prevalence of steatosis in this population.
• After a median follow-up of over 6 years, 12% developed liver complications despite SVR, underscoring the need for ongoing surveillance in high-risk patients.

Clinical Implications

Liver stiffness measurement remains a valuable and practical tool for risk stratification of liver complications after HCV cure. While the FAST score identifies patients at increased risk, it does not significantly enhance predictive performance beyond LS alone. Clinicians should continue to use LS to guide post-SVR surveillance strategies, especially in patients with advanced fibrosis or steatosis.

Conclusion

Both LS and the FAST score predict liver complications after HCV eradication, but LS alone provides robust prognostic information without added benefit from FAST. Continued monitoring of patients with elevated LS at SVR is essential to detect and manage liver-related events.

References

1. GEHEP-011 Cohort Study, 2024 -- Comparison of FibroScan-AST Score and Liver Stiffness in Predicting Liver Complications Following HCV Treatment Success