title: Association between hepatitis B virus basal core promoter/precore region mutations and the risk of hepatitis B-related acute-on-chronic liver failure in the Chinese population: an updated meta-analysis.
abstract: BACKGROUND
  The relationship between hepatitis B virus (HBV) mutations in basal core promoter (BCP) and precore (PC) regions and the risk of hepatitis B-related acute-on-chronic liver failure (HB-ACLF) remains uncertain.
  
  
  METHODS
  Databases were searched for papers that were published in English or Chinese until April 31, 2015. The odds ratios (ORs) of HBV mutation were pooled by using a fixed or random-effects model according to heterogeneity.
  
  
  RESULTS
  Data for 13 studies with a total of 1,149 HB-ACLF and 1,867 chronic hepatitis B (CHB) cases were retrieved. Statistically significant summary ORs for HB-ACLF were obtained for T1753V (1.99; 95 % confidence interval 1.30-3.02) and A1762T/G1764A (2.11; 95 %, 1.75-2.54) in the BCP region and for A1846T (3.33; 95 %, 2.23-4.97), G1896A (2.78; 95 %, 2.07-3.74), and G1899A (3.09; 95 %, 1.82-5.25) in the PC region. In subgroup analysis, BCP mutations were found to have higher ORs in age-matched studies, but PC mutations were found to have higher ORs in age-unmatched studies; patients with the mutations in HBV genotype C were more susceptible to HB-ACLF; patients with pre-existing liver cirrhosis had a higher risk of HB-ACLF occurrence. In sensitivity, specificity, and accuracy analysis, A1762T/G1764A had the highest sensitivity (67.43 %); A1762T/G1764A + G1896A triple mutations had the highest specificity (93.70 %); and T1753V + A1762T + G1764A mutation had the highest accuracy (65.42 %).
  
  
  CONCLUSIONS
  HBV T1753V, A1762T/G1764A, A1846T, G1896A, and G1899A mutations are correlated with an increase in the risk of HB-ACLF. These mutations alone and in combination may be predictive of the susceptibility of patients with CHB to developing HB-ACLF.
authors.affiliation: Institute of Infectious Diseases, 302 Teaching Hospital of Peking University, Beijing, 100039, China.
authors.forename: Xueyuan
authors.initials: X
authors.lastname: Nian
authors.affiliation: Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, 100039, China.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, 100039, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Infectious Disease, Peking University First Hospital, Beijing, 100034, China.
authors.forename: Jianhong
authors.initials: J
authors.lastname: Chen
authors.affiliation: Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, 100039, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Li
authors.affiliation: Institute of Infectious Diseases, 302 Teaching Hospital of Peking University, Beijing, 100039, China. xudongping302@sina.com.|Research Center for Clinical and Translational Medicine, Beijing 302 Hospital, Beijing, 100039, China. xudongping302@sina.com.
authors.forename: Dongping
authors.initials: D
authors.lastname: Xu
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000821:virology*; D000328:Adult; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006513:Hepatitis B e Antigens / Q000235:genetics*; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D016017:Odds Ratio; D011401:Promoter Regions, Genetic
chemical_list: D006513:Hepatitis B e Antigens
keywords: Acute-on-chronic liver failure; Hepatitis B virus; Meta-analysis; Mutation