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Determinants of the clinical outcome of patients with severe acute exacerbation of chronic hepatitis B virus infection

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Severe acute exacerbation of chronic hepatitis B can sometimes occur and lead to hepatic failure and death. The objective of this study was to elucidate the predictors of progression to hepatic decompensation during severe acute exacerbation.

Methods

We prospectively analyzed 37 consecutive patients with acute exacerbation of chronic hepatitis B (accompanied by jaundice and coagulopathy) for clinical outcome and factors that influenced the development of severe acute exacerbation, including viral kinetics.

Results

Fourteen (37.8%) patients progressed to severe acute exacerbation (accompanied by encephalopathy). Multivariate analysis identified serum bilirubin (>5 mg/dl, P = 0.002) as a significant determinant of progression to hepatic failure and prothrombin activity (<45%, P = 0.028) and as a determinant of liver-related death. The hepatitis B virus (HBV) DNA level before therapy was measured in 25 patients. HBV DNA levels increased or did not change from before commencement of treatment in all 11 patients who progressed to severe acute exacerbation. On the other hand, HBV DNA levels did not change or increased in 8 of 14 patients (57%) with acute exacerbation (P = 0.02).

Conclusions

Serum bilirubin and prothrombin activities were significant predictors of clinical outcome in patients with severe acute exacerbation of chronic hepatitis B. Viral kinetics until commencement of therapy can predict the severity of acute exacerbation of chronic hepatitis B.

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Abbreviations

AE:

Acute exacerbation

ALT:

Alanine aminotransferase

BCP:

Basal core promoter

CS:

Corticosteroid

HBV:

Hepatitis B virus

IFN:

Interferon

LMV:

Lamivudine

NA:

Nucleos(t)ide analogue

PC:

Pre-core

PT:

Prothrombin activity

SAE:

Severe acute exacerbation

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Acknowledgment

This study was supported in part by a Grant-in-aid from the Ministry of Health, Labor and Welfare of Japan.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Nami Mori, Fumitaka Suzuki, Yusuke Kawamura, Hitomi Sezaki, Tetsuya Hosaka, Norio Akuta, Masahiro Kobayashi, Satoshi Saito, Yoshiyuki Suzuki, Yasuji Arase, Kenji Ikeda & Hiromitsu Kumada

  2. Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan

    Mariko Kobayashi

Authors
  1. Nami Mori
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  2. Fumitaka Suzuki
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  3. Yusuke Kawamura
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  4. Hitomi Sezaki
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  5. Tetsuya Hosaka
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  6. Norio Akuta
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  9. Yoshiyuki Suzuki
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  13. Hiromitsu Kumada
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Corresponding author

Correspondence to Fumitaka Suzuki.

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Mori, N., Suzuki, F., Kawamura, Y. et al. Determinants of the clinical outcome of patients with severe acute exacerbation of chronic hepatitis B virus infection. J Gastroenterol 47, 1022–1029 (2012). https://doi.org/10.1007/s00535-012-0561-8

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  • DOI: https://doi.org/10.1007/s00535-012-0561-8

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