Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy.
OBJECTIVE
Chronic hepatitis B is a leading cause of death worldwide. To identify patients who might require urgent liver transplantation despite antiviral therapy, we investigated the determinants of early mortality in a large cohort of patients with decompensated chronic hepatitis B treated with lamivudine.


METHODS
One hundred fifty-four North American patients with decompensated chronic hepatitis B received lamivudine for a median of 16 months. Univariate and multivariate Cox regression modeling was used to develop a model of 6-month mortality.


RESULTS
A biphasic survival pattern was observed, with most deaths occurring within the first 6 months of treatment (25 of 32, 78%) because of complications of liver failure. The estimated actuarial 3-year survival of patients who survived at least 6 months was 88% on continued treatment. In multivariate modeling, elevated pretreatment serum bilirubin and creatinine levels as well as the presence of detectable hepatitis B virus (HBV) DNA (by the bDNA assay) pretreatment were significantly associated with 6-month mortality. An equation approximating the probability of early mortality was developed from these variables.


CONCLUSIONS
Our data demonstrate a distinct alteration in the slope of the survival curve after 6 months of lamivudine treatment for decompensated chronic hepatitis B. An equation consisting of 3 widely available pretreatment laboratory parameters was developed that can be used to predict the likelihood of early death in patients receiving lamivudine for decompensated chronic hepatitis B. These observations may help identify patients who can be stabilized with suppressive antiviral therapy vs. those who require urgent liver transplantation.
Fontana
Robert J
RJ
Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA. Rfontana@umich.edu
Hann
Hie-Won L
HW
Perrillo
Robert P
RP
Vierling
John M
JM
Wright
Theresa
T
Rakela
Jorge
J
Anschuetz
Gaya
G
Davis
Randy
R
Gardner
Stephen D
SD
Brown
Nathaniel A
NA
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis / Q000276:immunology; D006508:Hepatitis Antibodies / Q000032:analysis; D006513:Hepatitis B e Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
D000998:Antiviral Agents; D004279:DNA, Viral; D006508:Hepatitis Antibodies; D006513:Hepatitis B e Antigens; D019259:Lamivudine