Definition of disease progression

Whenever liver biopsy results were available, liver cirrhosis was diagnosed based on biopsy results. If biopsy results were absent, compensated cirrhosis was diagnosed by two of the following criteria: imaging showing nodular liver or splenomegaly, platelet count <100 × 10⁹/L in the absence of other explanations, liver stiffness measurement score of more than 13 kPa, or gastro-esophageal varices in endoscopy. Decompensated cirrhosis was defined as cirrhosis with sequelae such as: ascites, hepatic encephalopathy, variceal hemorrhage, or Child-Turcotte-Pugh (CTP) score ≥7. Overall-disease-progression was defined by any of the following events during follow-up: (1) newly diagnosed cirrhosis; (2) cirrhosis at baseline, CTP score increased 2 points or more; (3) progression from compensated cirrhosis to decompensated cirrhosis; (4) hepatocellular carcinoma; (5) liver transplantation; (6) death. Hepatocellular carcinoma, fatty liver disease, and type 2 diabetes were diagnosed using established guidelines.^[18–20] Patients’ HCV exposure history was used to estimate the time of their infection.^[7]