Bilirubin, aspartate aminotransferase and platelet count score: a novel score for differentiating patients with chronic hepatitis B with acute flare from acute hepatitis B.
BACKGROUND
Early therapy improves the outcome in patients with chronic hepatitis B with acute flare (CHB-AF). However in mesoendemic countries, it is difficult to differentiate CHBAF from acute hepatitis B (AHB). The aim of this study was to formulate a clinical score to differentiate CHB-AF from AHB in patients presenting with an acute hepatitis-like picture.


METHODS
Patients with a protracted clinical course of >2 months with elevated liver enzymes and positive hepatitis B virus DNA, who had undergone liver biopsy were included in this study. The clinical and laboratory profiles were compared between patients with biopsy suggestive of CHB-AF and AHB.


RESULTS
Of the 75 patients included, 32 patients had a liver biopsy suggestive of CHB-AF. At 6 months, HBsAg clearance was lower in the CHB-AF group (9.4 vs. 76.7%). Presence of prodrome, platelet count, aspartate aminotransferase (AST), alanine aminotransferase and bilirubin levels and presence of anti-core antibody (IgM anti HBc) were lower in CHB-AF group (P<0.01). Using the receiver operating characteristic curve, peak bilirubin level, peak AST levels and least platelet count within the first 8 weeks had the highest predictive power. Optimal values of platelet <2.4×105/µL, peak bilirubin <4.5 mg/dL and AST <550 IU/L were given a point each. On internal validation a score of 2 had 86% specificity, 70.1% sensitivity and 82.7% diagnostic accuracy in predicting CHB-AF.


CONCLUSIONS
Bilirubin, AST and platelet count (BAP) score may be helpful in differentiating CHB-AF from AHB. A score of >2 could strongly suggest CHB-AF. However the score requires further validation.
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Sojan George
SG
Kunnathuparambil
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Kattoor Ramakrishnan
KR
Vinayakumar
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Mahesh R
MR
Varma
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Rony
R
Thomas
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Premaletha
P
Narayanan
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Srijaya
S
Sreesh
BAP score; acute hepatitis B (AHB); chronic hepatitis B with acute flare (CHB-AF)