Abstract | BACKGROUND: 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:
|
Authors | Yao-Chun Hsu, Chun-Ying Wu, Chi-Yang Chang, Chih-Min Tai, Cheng-Hao Tseng, Daw-Shyong Perng, Lein-Ray Mo, Jaw-Town Lin |
Journal | Antiviral therapy
(Antivir Ther)
Vol. 18
Issue 2
Pg. 221-8
( 2013)
ISSN: 2040-2058 [Electronic] England |
PMID | 23128388
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
|
Chemical References |
|
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
|