title: Early mortality in Taiwanese lamivudine-treated patients with chronic hepatitis B-related decompensation: evaluation of the model for end-stage liver disease and index scoring systems as prognostic predictors.
abstract: BACKGROUND
  Both Model for End-stage Liver Disease (MELD) and Index scores have been used to predict mortality in patients with end-stage liver disease and cirrhosis in Western countries.
  
  
  OBJECTIVE
  This study aimed to determine mortality rates, identify prognostic indicators, and determine the usefulness of these 2 scoring systems in predicting short-term (6-month) survival in Taiwanese patients with chronic hepatitis B (CHB)-related decompensation who were treated with lamivudine.
  
  
  METHODS
  This study was conducted at the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan. Eligible patients were aged 18 to 85 years with CHB with related decompensation (with either serum total bilirubin level, >or=3 mg/dL or prolonged prothrombin time, >or=3 seconds) and were treatment naive. All patients were treated with lamivudine 100 mg PO (tablet) once daily; surviving patients were treated for at least 6 months. The clinical data, including hepatitis B surface antigen, hepatitis B e antigen, and hepatitis B virus (HBV) DNA, were measured before treatment. Pre-treatment MELD and Index scores were calculated for all patients.
  
  
  RESULTS
  Ninety-six patients were enrolled (79 men, 17 women; mean [SD] age, 44.5 [15.2] years). Thirteen (13.5%) patients died within 6 months. Higher international normalized ratio (INR) for prothrombin time, lower albumin level, and higher HBV DNA level (>or=10(5) copies/mL) were factors significantly associated with death. The areas under the receiver operating characteristic curve for predicting survival by the MELD and Index scores were 0.822 and 0.788, respectively. Albumin level, which was not included in the scoring systems, also was found to be a significant predictor.
  
  
  CONCLUSIONS
  : We found that with a 13.5% mortality rate, albumin, INR, and HBV DNA levels were good prognostic indicators in Taiwanese patients with CHB-related decompensation treated with lamivudine therapy. The MELD and Index scoring systems were good predictors of 6-month survival in the patients in this study.
authors.affiliation: Faculty of Internal Medicine, College o f Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chia-Yen
authors.initials: CY
authors.lastname: Dai
authors.forename: Wan-Long
authors.initials: WL
authors.lastname: Chuang
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Hou
authors.forename: Li-Po
authors.initials: LP
authors.lastname: Lee
authors.forename: Ming-Yen
authors.initials: MY
authors.lastname: Hsieh
authors.forename: Zu-Yau
authors.initials: ZY
authors.lastname: Lin
authors.forename: Shinn-Cherng
authors.initials: SC
authors.lastname: Chen
authors.forename: Jee-Fu
authors.initials: JF
authors.lastname: Huang
authors.forename: Ming-Yuh
authors.initials: MY
authors.lastname: Hsieh
authors.forename: Liang-Yen
authors.initials: LY
authors.lastname: Wang
authors.forename: Jun-Fa
authors.initials: JF
authors.lastname: Tsai
authors.lastname: Wen-Yu
authors.forename: Ming-Lung
authors.initials: ML
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006513:Hepatitis B e Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D014779:Virus Replication / Q000187:drug effects
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D019259:Lamivudine