4), which might propose the possibility that patients with early compensated liver cirrhosis might have been misstratified as having CHB according to clinical criteria. Finally, when the diagnosis of liver cirrhosis was made by clinical criteria and LSM simultaneously, the incidence of HCC was the highest (5.84%

person-year). All these results suggest that LSM might be a more reliable method for diagnosis of compensated liver cirrhosis than clinical criteria, and that LSM can identify the optimal time to recall surveillance program for these high-risk patients with compensated liver cirrhosis. Importantly, although the performance of LSM for the prediction of early compensated liver cirrhosis in cross-sectional studies has already been investigated,20, GSK458 solubility dmso 36 this is the first study to suggest

the usefulness of LSM in the diagnosis of early compensated liver cirrhosis in a prospective and longitudinal setting by investigating a clinical endpoint, defined as the risk of HCC development. Interestingly, the overall incidence of HCC differed significantly according to the LSM change (Fig. 5). These results GSK3235025 solubility dmso suggest that serial measurements of the LSM can be used as a dynamic indicator of the risk of HCC development; these findings are supported by previous studies.37 The incidence of liver-related complications was investigated further. However, the stratified LSM was not significant in the multivariate analysis. However, because the number of patients with HCC development and liver-related complications seems to be small in our study, confirmative longitudinal observation studies should be followed. Our study has some limitations. First, because liver biopsy data were not available at enrollment, the exact status of liver background was not informed; therefore, we could not provide additional information on the performance of LSM in predicting HCC development in comparison with liver biopsy. Second, the method we used to assess serum HBV DNA had low sensitivity, which caused difficulties in estimating the association between the serum HBV DNA

level and HCC development and in characterizing our study population completely from inactive 上海皓元医药股份有限公司 carriers to active hepatitis. Third, our follow-up period was relatively short; consequently, the role of LSM as a predictor of HCC development in patients with CHB should be confirmed in subsequent studies with long-term follow-up periods. Finally, our results can only be applied to a subpopulation of patients with CHB showing limited ALT level (≤5 times the upper limit of normal).33, 38 However, when ALT levels subside after active antiviral treatment in patients with elevated ALT, the reliability of LSM may be restored as indicated in the previous study,38 and LSM may be used as a significant predictor of HCC development.