title: Differentiation of acute and chronic hepatitis B in IgM anti-HBc positive patients.
abstract: OBJECTIVE
  To identify the factors that differentiate acute hepatitis B (AHB) from chronic hepatitis B with acute exacerbation (CHB-AE).
  
  
  METHODS
  From 2004 to 2013, a total of 82 patients (male n = 52, 63.4%; female n = 30, 36.6%) with clinical features of acute hepatitis with immunoglobulin M antibodies to the hepatitis B core antigen (IgM anti-HBc) were retrospectively enrolled and divided into two groups; AHB (n = 53) and CHB-AE (n = 29). The AHB group was defined as patients without a history of hepatitis B virus (HBV) infection before the episode and with loss of hepatitis B surface antigen within 6 mo after onset of acute hepatitis. Biochemical and virological profiles and the sample/cutoff (S/CO) ratio of IgM anti-HBc were compared to determine the differential diagnostic factors.
  
  
  RESULTS
  The multivariate analysis demonstrated that, the S/CO ratio of IgM anti-HBc and HBV DNA levels were meaningful factors. The S/CO ratio of IgM anti-HBc was significantly higher in the AHB group, while the HBV DNA level was significantly higher in the CHB-AE group. The optimal cutoff values of IgM anti-HBc and HBV DNA levels for differentiating the two conditions were 8 S/CO ratio and 5.5 log₁₀ IU/mL, respectively. The sensitivity and specificity were 96.2% and 89.7% for the S/CO ratio of IgM anti-HBc and 81.1% and 72.4% for HBV DNA levels, respectively. The area under receiver operating characteristic curves of both the S/CO ratio of IgM anti-HBc and HBV DNA levels were not significantly different (0.933 vs 0.844, P = 0.105). When combining IgM anti-HBc and HBV DNA, the diagnostic power significantly improved compared to HBV DNA alone (P = 0.0056). The combination of these factors yielded a sensitivity and specificity of 98.1% and 86.2%, respectively.
  
  
  CONCLUSIONS
  The combination of the S/CO ratio of IgM anti-HBc and HBV DNA levels was a useful tool for differentiating AHB from CHB-AE in patients with positive IgM anti-HBc.
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Ji Won
authors: JW
authors: Park
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Kyeong Min
authors: KM
authors: Kwak
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Sung Eun
authors: SE
authors: Kim
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Myoung Kuk
authors: MK
authors: Jang
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Dong Joon
authors: DJ
authors: Kim
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Myung Seok
authors: MS
authors: Lee
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Hyoung Su
authors: HS
authors: Kim
authors: Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea.
authors: Choong Kee
authors: CK
authors: Park
mesh_terms: D000208:Acute Disease; D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D007075:Immunoglobulin M
keywords: Acute hepatitis; Chronic hepatitis; Differential diagnosis; Hepatitis B virus