title: Determinants of the clinical outcome of patients with severe acute exacerbation of chronic hepatitis B virus infection.
abstract: BACKGROUND
  Severe acute exacerbation of chronic hepatitis B can sometimes occur and lead to hepatic failure and death. The objective of this study was to elucidate the predictors of progression to hepatic decompensation during severe acute exacerbation.
  
  
  METHODS
  We prospectively analyzed 37 consecutive patients with acute exacerbation of chronic hepatitis B (accompanied by jaundice and coagulopathy) for clinical outcome and factors that influenced the development of severe acute exacerbation, including viral kinetics.
  
  
  RESULTS
  Fourteen (37.8%) patients progressed to severe acute exacerbation (accompanied by encephalopathy). Multivariate analysis identified serum bilirubin (>5 mg/dl, P = 0.002) as a significant determinant of progression to hepatic failure and prothrombin activity (<45%, P = 0.028) and as a determinant of liver-related death. The hepatitis B virus (HBV) DNA level before therapy was measured in 25 patients. HBV DNA levels increased or did not change from before commencement of treatment in all 11 patients who progressed to severe acute exacerbation. On the other hand, HBV DNA levels did not change or increased in 8 of 14 patients (57%) with acute exacerbation (P = 0.02).
  
  
  CONCLUSIONS
  Serum bilirubin and prothrombin activities were significant predictors of clinical outcome in patients with severe acute exacerbation of chronic hepatitis B. Viral kinetics until commencement of therapy can predict the severity of acute exacerbation of chronic hepatitis B.
authors.affiliation: Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
authors.forename: Nami
authors.initials: N
authors.lastname: Mori
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Suzuki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Hitomi
authors.initials: H
authors.lastname: Sezaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hosaka
authors.forename: Norio
authors.initials: N
authors.lastname: Akuta
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Saito
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Arase
authors.forename: Kenji
authors.initials: K
authors.lastname: Ikeda
authors.forename: Mariko
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kumada
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood*; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D007565:Jaundice / Q000175:diagnosis; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011516:Prothrombin / Q000378:metabolism*; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D005938:Glucocorticoids; D016898:Interferon-alpha; D019259:Lamivudine; D011516:Prothrombin; D000410:Alanine Transaminase; D001663:Bilirubin