title: Prognostic factors in severe exacerbation of chronic hepatitis B.
abstract: 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.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
authors.forename: Erwin
authors.initials: E
authors.lastname: Sablon
authors.forename: Chee-Kin
authors.initials: CK
authors.lastname: Hui
authors.forename: Tak-Ming
authors.initials: TM
authors.lastname: Li
authors.forename: He-Jun
authors.initials: HJ
authors.lastname: Yuan
authors.forename: Danny Ka-Ho
authors.initials: DK
authors.lastname: Wong
authors.forename: Joke
authors.initials: J
authors.lastname: Doutreloigne
authors.forename: Veerle
authors.initials: V
authors.lastname: Bogaerts
authors.forename: Benjamin Chun-Yu
authors.initials: BC
authors.lastname: Wong
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Lai
mesh_terms: 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
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D019259:Lamivudine