Case-control study for the identification of virological factors associated with fulminant hepatitis B.
BACKGROUND
Host and viral factors can promote the development of fulminant hepatitis B (FHB), but there have been no case-control studies for figuring out virological parameters that can distinguish FHB.


METHODS
In a case-control study, virological factors associated with the development of FHB were sought in 50 patients with FH developed by transient hepatitis B virus (HBV) infection (FH-T) and 50 with acute self-limited hepatitis B (AHB) who were matched for sex and age. In addition, 12 patients with FH developed by acute exacerbation (AE) of asymptomatic HBV carrier (ASC) (FH-C) were also compared with 12 patients without FH by AE of chronic hepatitis B (AE-C).


RESULTS
Higher HBV DNA levels, subgenotype B1/Bj, A1762T/G1764A, G1896A, G1899A and A2339G mutation were significantly more frequent (P < 0.05), while hepatitis B e-antigen was less frequent in the FH-T patients than AHB. In multivariate analysis, G1896A mutation (odds ratio [OR], 13.53; 95% confidence interval [CI], 2.75-66.64), serum HBV DNA more than 5.23 log copies/mL (OR, 5.14; 95% CI, 1.10-24.15) and total bilirubin more than 10.35 mg/mL (OR, 7.81; 95% CI, 1.77-34.51) were independently associated with a fulminant outcome by transient HBV infection. On the other hand, in comparison with the patients between FH-C and AE-C groups, there was no significant difference of virological factors associated with the development of FHB.


CONCLUSIONS
A number of virological factors have been defined that may distinguish FH-T from AHB in a case-control study. The pathogenic mechanism of FHB between transient HBV infection and AE of ASC would be different.
Kusakabe
Atsunori
A
Department of Clinical Molecular Informative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Tanaka
Yasuhito
Y
Mochida
Satoshi
S
Nakayama
Nobuaki
N
Inoue
Kazuaki
K
Sata
Michio
M
Isoda
Norio
N
Kang
Jong-Hon
JH
Sumino
Yasukiyo
Y
Yatsuhashi
Hiroshi
H
Takikawa
Yasuhiro
Y
Kaneko
Shuichi
S
Yamada
Gotaro
G
Karino
Yoshiyasu
Y
Tanaka
Eiji
E
Kato
Junji
J
Sakaida
Isao
I
Izumi
Namiki
N
Sugauchi
Fuminaka
F
Nojiri
Shunsuke
S
Joh
Takashi
T
Miyakawa
Yuzo
Y
Mizokami
Masashi
M