ORIGINAL ARTICLE Liver stiffness predicts the response to direct-acting antiviral-based therapy against chronic hepatitis C in cirrhotic patients K. Neukam 1 & L. E. Morano-Amado 2 & A. Rivero-Juárez 3 & J. Macías 1 & R. Granados 4 & A. Romero-Palacios 5 & M. Márquez 6 & D. Merino 7 & E. Ortega 8 & J. C. Alados-Arboledas 9 & J. Cucurull 10 & M. Omar 11 & P. Ryan-Murua 12 & J. A. Pineda 1 & On behalf of the Grupo de Estudio de Hepatitis Vírica, of the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica: GEHEP-SEIMC and Grupo de Estudio de Hepatitis Vírica, of the Sociedad Andaluza de Enfermedades Infecciosas y Microbiología Clínica: HEPAVIR/Red de Investigación en SIDA (RIS-HEP07) Received: 17 October 2016 /Accepted: 7 December 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract The purpose of this investigation was to evaluate the impact of liver stiffness (LS) on the response to direct- acting antiviral (DAA)-based therapy against hepatitis C virus (HCV) infection in cirrhotic patients. Those patients included in two Spanish prospective cohorts of patients receiving ther- apy based on at least one DAA, who showed a baseline LS ≥ 12.5 kPa and who had reached the scheduled time point for sustained virological response evaluation 12 weeks after com- pleting therapy (SVR12) were analysed. Pegylated interferon/ ribavirin-based therapy plus an HCV NS3/4A protease inhib- itor (PR-PI group) was administered to 198 subjects, while 146 received interferon-free regimens (IFN-free group). The numbers of patients with SVR12 according to an LS < 21 kPa versus ≥21 kPa were 59/99 (59.6%) versus 46/99 (46.5%) in the PR-PI group (p = 0.064) and 41/43 (95.3%) versus 90/103 (87.4%) in the IFN-free group (p = 0.232). Corresponding figures for the relapse rates in those who presented end-of- treatment response (ETR) were 3/62 (4.8%) versus 10/56 (17.9%, p = 0.024) and 1/42 (2.4%) versus 8/98 (8.2%, p = 0.278), respectively. In a multivariate analysis adjusted for age, sex and use of interferon, a baseline LS ≥ 21 kPa was identified as an independent predictor of relapse [adjusted odds ratio, AOR (95% confidence interval, CI): 4.228 (1.344–13.306); p = 0.014] in those patients with ETR. LS * K. Neukam karin.neukam@gmail.com 1 Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain 2 Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain 3 Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Maimónides Institute of Biomedical Investigation of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain 4 Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain 5 Unit of Infectious Diseases, Hospital Universitario Puerto Real, Puerto Real, Spain 6 Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain 7 Unit of Infectious Diseases, Complejo Hospitalario Universitario de Huelva, Huelva, Spain 8 Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain 9 Unit of Infectious Diseases and Microbiology, AGS Norte de Cádiz, Jerez de la Frontera, Spain 10 Service of Internal Medicine, Hospital de Figueres-Fundació Salut Empordà, Figueres, Spain 11 Unit of Infectious Diseases, Complejo Hospitalario de Jaén, Jaen, Spain 12 Internal Medicine Service, Hospital Universitario Infanta Leonor, Madrid, Spain Eur J Clin Microbiol Infect Dis DOI 10.1007/s10096-016-2871-x