# Ultrasound-Based Liver Stiffness Surveillance in Patients Treated for Chronic Hepatitis B or C
## 2 Chc
In addition to stratification by the SVR status, baseline liver stiffness values outweighed SVRs in the various regression analyses adopting various baseline and chronological host and viral covariates to explain the declines in liver stiffness [37; 38; 39; 40] (Table 1). Declines in liver stiffness tended to be greater in patients with higher baseline liver stiffness values, reflecting the effects of biochemical response on liver stiffness over time [29]. Moreover, the heterogeneity of liver stiffness declines in the group without an SVR (i.e., in several studies, those who relapsed still could achieve a significant reduction in liver stiffness) [30; 37; 38] also contributed to the nonsignificant effect of SVR status on the declines in liver stiffness over time. In a recent study [38], approximately 80% of patients experienced a decline in paired liver stiffness values from the baseline to the SVR visit in the stratified subgroups. The overall percentages of patients who exhibited any decline in liver stiffness did not differ significantly among the SVR (80.8%, 177/219), relapse (77.8%, 21/27), and nonresponse (80.0%, 8/10) groups. Similarly, in a previous study [41], 250 (76.2%) out of 328 patients who received DAA-based therapy and paired liver stiffness measurements exhibited an improvement in liver stiffness from the baseline to the SVR visit 12 weeks after treatment. After adjustment for other baseline covariates through regression analyses, several individual non-pooling studies [30; 35; 37] identified baseline hepatic necroinflammation or a necroinflammatory decline over time from the study entry date as being significantly correlated with a decline in liver stiffness. Biochemical responses were also revealed to be in parallel with the liver stiffness decline over time [38]. However, only one study has analyzed the two-phased liver stiffness declines or the rapid-to-slow rates of liver stiffness kinetics (typically declines) through liver stiffness surveillance at shorter time intervals by including patients with CHB [7]. Among the noninvasive liver fibrosis evaluation approaches or indices, elastography-based liver stiffness measurements in particular were affected at an early stage by hepatic necroinflammatory activity [32]. The activity typically remained relatively stable over the later phase. After ALT normalization, liver stiffness continued to decline gradually, reflecting the ongoing occurrence of fibrosis reversal over time [7; 8]. Therefore, lower cutoff values than those acquired at the treatment baseline have been recommended for surveillance by dichotomizing the fibrosis stages in patients with CHC using elastography on and off treatments [32; 34; 42]. Furthermore, a large-scale study is required to validate these proposed cutoff values for the prediction of fibrosis stage in treatment-experienced patients. Moreover, experiences in both clinical and research settings have revealed concordances and discordances between different fibrosis evaluation measures [43]. However, a combination of evaluation measures may enhance diagnostic performance [43; 44]. Despite the lack of a critical evaluation of the potential for publication bias and quality and pooling of the original data for overall estimations among the reviewed contributions, the current study provides valuable perspectives regarding liver stiffness surveillance. In addition to virologic response and biochemical response, surges in the trajectories of liver stiffness values over time may provide a warning for conditions such as hyperbilirubinemia or excessive necroinflammatory flare-ups, particularly during DAA therapy for CHC, excessive alcohol consumption, exposure to hepatotoxins, viral reactivations, superinfections, or relapses. Among patients that ordinarily experience declining liver stiffness values over time, any marked increase in liver stiffness may prompt medical professionals to implement further differential diagnoses for the examinee, potentially requiring further medical attention at any time point during surveillance.