Prognostic factors in severe exacerbation of chronic hepatitis B.
Forty-seven patients with severe hepatitis B exacerbation were compared with patients who had mild exacerbation (n=96) or no exacerbation (n=96). Seventeen patients (36.2%) died or underwent liver transplantation. Preexisting cirrhosis and a prothrombin time (PT) of >30 s were associated with adverse outcome in 60.9% and 87.5% of patients, respectively. The rate of adverse outcome increased to 92.3% when albumin levels of < or =35 g/L and bilirubin levels of >200 microM were present. Other factors associated with adverse outcomes included peak bilirubin level, peak PT, time to reach peak PT, and the presence of encephalopathy and/or ascites. There was no difference in the frequency of precore mutations in patients with severe or mild exacerbation or without exacerbation. A significantly lower prevalence of core promoter mutants was found in patients with severe exacerbation (50%), compared with those who had mild exacerbation (81.3%; P=.004). Patients with severe exacerbation of hepatitis B with poor prognostic factors should be considered for early liver transplantation.
Yuen
Man-Fung
MF
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Sablon
Erwin
E
Hui
Chee-Kin
CK
Li
Tak-Ming
TM
Yuan
He-Jun
HJ
Wong
Danny Ka-Ho
DK
Doutreloigne
Joke
J
Bogaerts
Veerle
V
Wong
Benjamin Chun-Yu
BC
Fan
Sheung-Tat
ST
Lai
Ching-Lung
CL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites; D015415:Biomarkers; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D005355:Fibrosis / Q000209:etiology; D006501:Hepatic Encephalopathy; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011401:Promoter Regions, Genetic; D012698:Serologic Tests
D015415:Biomarkers; D004279:DNA, Viral; D019259:Lamivudine