title: Clinical outcomes of lamivudine-adefovir therapy in chronic hepatitis B cirrhosis.
abstract: OBJECTIVE
  To determine the clinical outcome of chronic hepatitis B cirrhotics on antiviral therapy.
  
  
  BACKGROUND
  The long-term outcome of hepatitis B cirrhotics on therapy remains to be characterized.
  
  
  METHODS
  A large clinic cohort of chronic hepatitis B cirrhotic patients were enrolled in a treatment program of lamivudine ± adefovir therapy. Patients were analyzed for clinical outcomes, and predictors of these outcomes were evaluated by multivariate analysis. Clinical outcomes of ascites, encephalopathy, hepatocellular carcinoma (HCC), and progression in Child-Pugh score, Model for End-stage Liver Disease score, and mortality were assessed. Data were analyzed by Kaplan-Meier graphs, log-rank test, and Cox regression.
  
  
  RESULTS
  Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated cirrhosis. At 5 years, the mean survival was 83.6%, development of ascites, HCC, encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%, and 16.9%, respectively. The overall progression of liver-related complications was 32.8% at 5 years. Multivariate analysis showed that ascites, albumin ≤28 g/L, Child-Pugh score ≥7.9, Model for End-stage Liver Disease score ≥10.9 were significantly associated with liver-related complications. Low albumin and low hepatitis B virus DNA were independent factors for liver-associated mortality. Lamivudine resistance did not affect mortality or liver disease progression. When stratified by Child-Pugh status, the mean survival of those with Child C cirrhosis was worse than Child A and B cirrhosis (P<0.001, log-rank test). Early deaths (≤12 mo) were due to liver failure or sepsis, whereas deaths ≥12 mo were mainly due to HCC.
  
  
  CONCLUSIONS
  Decompensated chronic hepatitis B cirrhotics may suffer early mortality despite antiviral treatment, and therefore should be considered for early liver transplantation.
authors.affiliation: Department of Gastroenterology and Hepatology, Yong Yoo Lin School of Medicine, National University of Singapore, Singapore. mdclimsg@nus.edu.sg
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
authors.forename: Myat Oo
authors.initials: MO
authors.lastname: Aung
authors.forename: Belinda
authors.initials: B
authors.lastname: Mak
authors.forename: Dede
authors.initials: D
authors.lastname: Sutedja
authors.forename: Yin Mei
authors.initials: YM
authors.lastname: Lee
authors.forename: Guan Huei
authors.initials: GH
authors.lastname: Lee
authors.forename: Mark
authors.initials: M
authors.lastname: Fernandes
authors.forename: How Cheng
authors.initials: HC
authors.lastname: Low
authors.forename: Vincent
authors.initials: V
authors.lastname: Lai
authors.forename: Yock Young
authors.initials: YY
authors.lastname: Dan
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D019259:Lamivudine / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063065:Organophosphonates / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000225:Adenine