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Pretreatment viral DNA stratifies mortality risk in patients receiving antiviral therapy for severe acute exacerbation of chronic hepatitis B.

AbstractBACKGROUND:
Prognostic factors have not been elucidated for severe acute exacerbation of chronic hepatitis B treated with antiviral therapy. This study aimed to explore the role of baseline viral load in predicting mortality.
METHODS:
This retrospective cohort study screened consecutive chronic hepatitis B patients (n=84) receiving antiviral therapy for severe acute exacerbation, defined as abrupt elevation of serum alanine aminotransferase >10× the upper limit of normal along with hyperbilirubinaemia. Survival pattern was evaluated by the Kaplan-Meier method and predictors for mortality determined by the Cox regression analysis.
RESULTS:
A total of 66 patients were eligible and followed-up for a median of 23 months (range 0.1-75.0). Overall, 20 (30.3%) patients died during the study period, with the vast majority (n=17) succumbing rapidly within 3 months of severe acute exacerbation. The multivariate Cox model revealed that mortality was associated with baseline viral DNA level (HR 1.49 per log copies/ml, 95% CI 1.13, 1.96), international normalized ratio for prothrombin time (HR 2.68 per unit, 95% CI 1.81, 3.98), platelet count (HR 0.87 per 10(4) cells/μl, 95% CI 0.78, 0.98) and age (HR 1.10 per year, 95% CI 1.05, 1.15). A significant interaction existed between viral DNA and prolonged prothrombin time (P=0.005). Stratified analyses further demonstrated that pronounced coagulopathy heralded death irrespective of viral load, whereas serum level of viral DNA stratified mortality risk among those without marked coagulopathy.
CONCLUSIONS:
Pretreatment viral DNA level stratifies risk of death in patients with severe acute exacerbation of chronic hepatitis B before the manifestation of overt liver failure.
AuthorsYao-Chun Hsu, Chun-Ying Wu, Chi-Yang Chang, Chih-Min Tai, Cheng-Hao Tseng, Daw-Shyong Perng, Lein-Ray Mo, Jaw-Town Lin
JournalAntiviral therapy (Antivir Ther) Vol. 18 Issue 2 Pg. 221-8 ( 2013) ISSN: 2040-2058 [Electronic] England
PMID23128388 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antiviral Agents
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents (therapeutic use)
  • Disease Progression
  • Female
  • Hepatitis B, Chronic (drug therapy, mortality, virology)
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Treatment Outcome
  • Viral Load
  • Young Adult

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