title: The effect of lamivudine therapy in hepatic decompensation during acute exacerbation of chronic hepatitis B.
abstract: OBJECTIVE
  Severe acute exacerbation (AE) of chronic hepatitis B (CHB) can lead to hepatic decompensation and death. The aim of this study was to investigate the effect of lamivudine therapy in hepatic decompensation during such AEs.
  
  
  METHODS
  In a 10-month period, a total of 60 consecutive AE patients with jaundice and prolonged prothrombin time over 3s were treated with lamivudine 150 mg daily. As a historical control, another 31 CHB patients with AE resulting in hepatic decompensation hospitalized in an immediate past 6-month period were enrolled for comparison.
  
  
  RESULTS
  Patients in both groups were comparable in clinical and biochemical features. After a median treatment period of 6 weeks (range 1-48 weeks), all of the 25 patients with pretherapy bilirubin level < 20 mg/dl in the treatment group survived, while five (25%) of 20 patients in the control group died (P=0.013; odds ratios, 2.667; 95% confidence interval, 1.787-3.979). However, the mortality rate was similar in patients with pretherapy bilirubin level > or =20 mg/dl in both groups.
  
  
  CONCLUSIONS
  These results suggest that lamivudine may prevent fatality in CHB patients with hepatic decompensation if therapy starts early enough or before serum bilirubin level rise over 20 mg/dl, but helps little if serum level already risen over that level.
authors.affiliation: Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, 199 Tung Hwa North Road, Taipei, 105 Taiwan.
authors.forename: Rong-Nan
authors.initials: RN
authors.lastname: Chien
authors.forename: Chia-Hsien
authors.initials: CH
authors.lastname: Lin
authors.forename: Yun-Fan
authors.initials: YF
authors.lastname: Liaw
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016019:Survival Analysis
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D001663:Bilirubin