title: The presence of hepatitis B core antibody is associated with more advanced liver disease in alcoholic patients with cirrhosis.
abstract: BACKGROUND
  Liver disease is more severe in patients with chronic hepatitis B virus (HBV) infections and alcohol-induced liver injury. Whether the same is true for alcoholic patients with cirrhosis who have recovered from previous HBV infections remains to be determined.
  
  
  OBJECTIVE
  To document the extent of liver disease in alcoholic patients with cirrhosis who test negative for hepatitis B surface antigen (HBsAg) and test positive for antibody to hepatitis B core antigen (anti-HBc).
  
  
  METHODS
  Two hundred fifty-four alcoholic patients with cirrhosis were divided into anti-HBc-positive (N = 171) and anti-HBc-negative (N = 83) cohorts. Demographic, clinical, and biochemical features were retrospectively analyzed. Prognostic scores and the prevalence of patients at high risk for short-term mortality were calculated. Logistic regression was used to identify factors associated with an increased risk for short-term mortality.
  
  
  RESULTS
  Jaundice was more common in the anti-HBc-positive cohort (32.2% vs. 18.1%, p = 0.02). This cohort also had higher serum bilirubin (70.9 vs. 50.4 μM/L, p = 0.03), prothrombin times (15.6 vs. 14.4 s, p = 0.01), MELD scores (8.5 vs. 4.6, p = 0.01), i-MELD scores (28.6 vs. 24.7, p = 0.03), MDF scores (14.2 vs. 6.8, p = 0.02) and ABIC scores (7.2 vs. 6.6, p = 0.01). In addition, anti-HBC-positive patients were more often at high risk for short-term mortality (40.4% vs. 26.5%, p = 0.03). Multivariate analysis identified anti-HBc-positive status (OR: 1.84; 95% CI: 1.10-3.36) and alcohol intake ≥150 g/day (OR: 2.01; 95% CI: 1.10-3.66) as independent risk factors for high risk of mortality.
  
  
  CONCLUSIONS
  The anti-HBc-positive state is associated with more advanced liver disease in alcoholic patients with cirrhosis. A prospective study including HBV-DNA testing and liver biopsies should be considered to validate and further elucidate these findings.
authors.affiliation: Department of Hepatology, First Hospital of Jilin University, No. 71, Xinmin Street, Changchun 130021, China.
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Zhang
authors.forename: Ruihong
authors.initials: R
authors.lastname: Wu
authors.forename: Jing
authors.initials: J
authors.lastname: Jiang
authors.forename: Gerald Y
authors.initials: GY
authors.lastname: Minuk
authors.forename: Junqi
authors.initials: J
authors.lastname: Niu
mesh_terms: D000328:Adult; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000276:immunology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens
keywords: ABIC; ACHE; ALB; ALP; ALT; AST; Alcoholic; Anti HBc; Anti-HBc; Anti-HBe; Anti-HBs; Anti-HCV; DALY; DBIL; GGT; HBV; HBeAg; HCC; Hepatitis B virus; INR and creatinine score; IQR; Liver cirrhosis; MDF; MELD; Maddrey's discriminant function; Mayo End-Stage Liver Disease; PLT; PT; Prognosis; TBIL; alanine aminotransferase; albumin; alkaline phosphatase; antibodies to hepatitis C virus; antibody to HBeAg; antibody to hepatitis B core antigen; antibody to hepatitis B surface antigen; aspartate aminotransferase; bilirubin; cholinesterase; direct bilirubin; disability-adjusted life-years; hepatitis B e antigen; hepatitis B virus; hepatocellular carcinoma; i-MELD; integrated-MELD; interquartile ranges; platelet; prothrombin time; total bilirubin; γ-glutamyltranspeptidase