title: [The impact of early rapid virological response on the outcomes of hepatitis B associated acute on chronic liver failure during antiviral treatment].
abstract: OBJECTIVE
  To investigate the impact of early rapid virological response on the outcomes of hepatitis B associated acute on chronic liver failure during antiviral treatment.
  
  
  METHODS
  106 acute on chronic liver failure patients in our hospital from January 2008 to July 2010 were enrolled in present study retrospectively. Besides internal medicine therapy, all patients received lamivudine (100 mg/d) or entecavir (0.5 mg/d) treatment. The profile of liver biochemistry, prothrombin time activity and viral load were detected at baseline and week 4, respectively. The patients were divided into HBV DNA negative group and HBV DNA positive group according to the viral load at week 4. The clinical features and treatment outcomes were compared between groups. Frequency variables were compared by x2 test or Fisher's exact test. Continuous variables were compared using independent samples T-test. The factors that impact on the treatment outcomes were determined using stepwise multivariate logistic regression analysis.
  
  
  RESULTS
  At the week 4, the TBil and PTA in HBV DNA positive group [(261.6+/-205.6)mumol/L and 44.7%+/-19.7%, respectively] were significantly different from those in HBV DNA negative group [(160.1+/-173.4) mumol/L and 56.8%+/-23.1%, respectively] ( t = 2.190 and -2.077, respectively, P less than 0.05). The non-effective rate of HBVDNA positive group (50%, 9/18) was significantly higher than that of HBV DNA negative group (14.8%, 13/88) (x2 = 9.235, P less than 0.01). By using stepwise multivariate logistic regression analysis, the disease stage and HBV DNA undetectable at week 4 were the independent factor. The OR values of disease stage and HBV DNA undetectable were 6.559 and 0.209, respectively, and 95% CI was 2.316~18.576 and 0.058~0.747, respectively.
  
  
  CONCLUSIONS
  The rapid suppression of viral load by nucleotide analogue may improve the efficacy of hepatitis B associated acute on chronic liver failure treatment. The early rapid virological response within first 4 weeks may contribute to the prediction of the treatment outcomes.
authors.affiliation: Fuzhou Municipal Infectious Disease Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.forename: Cai-xia
authors.initials: CX
authors.lastname: Zheng
authors.forename: Ming-hua
authors.initials: MH
authors.lastname: Lin
authors.forename: Qiao-rong
authors.initials: QR
authors.lastname: Gan
authors.forename: Rong-sheng
authors.initials: RS
authors.lastname: Lin
authors.forename: Hai-bing
authors.initials: HB
authors.lastname: Gao
authors.forename: Jian-rong
authors.initials: JR
authors.lastname: Huang
authors.forename: Chen
authors.initials: C
authors.lastname: Pan
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D058625:End Stage Liver Disease / Q000188:drug therapy* / Q000821:virology*; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy*; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral