title: Pretreatment HBsAg level and an early decrease in MELD score predict prognosis to lamivudine treatment for HBeAg-negative acute-on-chronic liver failure.
abstract: OBJECTIVE
  Few data are available about the predictability of HBsAg quantification to nucleos(t)ide analogues treatment in acute-on-chronic liver failure (ACLF). The aim of this study was to investigate HBsAg level combined with the model for end-stage liver disease (MELD) score for predicting prognosis to lamivudine monotherapy in HBeAg-negative ACLF.
  
  
  METHODS
  Fifty-seven nucleoside-naïve patients with HBeAg-negative ACLF were treated with 100mg of lamivudine daily. Serum levels of HBsAg, HBV DNA and biochemical items were detected at baseline, before death (patients died within 3months) or month 3 meanwhile MELD score was calculated. Dynamic of these items and 3-month mortality were analyzed.
  
  
  RESULTS
  HBV DNA level significantly decreased while HBsAg level did not after treatment. Twenty-six patients died within 3months and the others survived. Regardless pre- or post-treatment, HBsAg level of survival group was significantly higher than that of dead group meanwhile MELD scores of the former were significantly lower than those of the latter (all P<0.05). Post-treatment MELD scores of 32 patients with pretreatment HBsAg levels above 4000 COI were significantly lower than those of 25 patients below to it (t=-2.116, P=0.044) and the 3-month mortality of the formers was significantly lower than that of the latter (34.3% [11/32] vs 64.0% [16/25], χ(2)=4.941, P=0.026).
  
  
  CONCLUSIONS
  In HBeAg-negative ACLF, patient with higher pretreatment HBsAg levels and early decrease in MELD score has lower 3-month mortality than one without it during lamivudine monotherapy.
authors.affiliation: Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, No 600# Tianhe Road, Guangzhou 510630, P.R. China. Electronic address: yankee2@21.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Lai
authors.affiliation: Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, No 600# Tianhe Road, Guangzhou 510630, P.R. China.
authors.forename: Chao-Shuang
authors.initials: CS
authors.lastname: Lin
authors.affiliation: Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, No 600# Tianhe Road, Guangzhou 510630, P.R. China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, No 600# Tianhe Road, Guangzhou 510630, P.R. China.
authors.forename: Shu-Ru
authors.initials: SR
authors.lastname: Chen
authors.affiliation: Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, No 600# Tianhe Road, Guangzhou 510630, P.R. China.
authors.forename: Ye-Qiong
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, No 600# Tianhe Road, Guangzhou 510630, P.R. China.
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Ke
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000235:genetics; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine