title: The association between circulating oestradiol levels and severity of liver disease in males with hepatitis B virus infection.
abstract: BACKGROUND
  Males have a strikingly increased risk of advanced liver disease. This study was designed to investigate the association between sex hormone levels and different disease states in hepatitis B virus (HBV)-infected male patients.
  
  
  METHODS
  Two hundred and fifty-two male patients, including 30 with acute hepatitis B (AHB), 127 with chronic hepatitis B (CHB) and 95 with chronic severe hepatitis B (CSHB), and 48 healthy controls (HCs) were enroled in this study. All patients were followed for 4 months. The primary end point was in-hospital mortality at the end of 90 days. At study entry, a blood sample was collected from all subjects to examine liver function, renal function and sex hormone levels (serum total testosterone and oestradiol). A total of nine clinical chemistry and biochemical variables were analyzed for possible association with outcomes by using Cox proportional hazards and multiple regression models.
  
  
  RESULTS
  We demonstrated that in CSHB and CHB patients, oestradiol levels were significantly increased compared with HCs and AHB patients, whereas no significant differences were observed in AHB patients and HCs. All male patients had normal levels of testosterone which were not significantly different compared with those of HCs. Increased oestradiol levels were clinically associated with severe liver disease, and increased 3-month mortality rate. Multivariate analysis demonstrated that oestradiol and the model for end-stage liver disease (MELD) score were independent predictors for mortality (both P < 0.001).
  
  
  CONCLUSIONS
  Oestradiol levels are significantly increased in male patients with hepatitis B, and were associated with the severity of liver disease. Moreover, elevation of oestradiol is an independent predictive factor for the 3-month mortality rate in male patients with hepatitis B.
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.
authors.forename: Wei L
authors.initials: WL
authors.lastname: Mao
authors.forename: Xin P
authors.initials: XP
authors.lastname: Shi
authors.forename: Yu F
authors.initials: YF
authors.lastname: Lou
authors.forename: Bo
authors.initials: B
authors.lastname: Ye
authors.forename: Yuan Q
authors.initials: YQ
authors.lastname: Lu
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018450:Disease Progression; D004958:Estradiol / Q000097:blood*; D006509:Hepatitis B / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013739:Testosterone / Q000097:blood; D013997:Time Factors; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D013739:Testosterone; D004958:Estradiol
keywords: hepatitis B virus infection; oestradiol; sex hormone