The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) to identify malnutrition risk in patients with liver disease. However, little is known about the application of RFH-NPT to screen for the risk of malnutrition in China, where patients primarily suffer from hepatitis virus-related cirrhosis. A total of 155 cirrhosis patients without liver cancer or uncontrolled comorbid illness were enrolled in this prospective study. We administered the Nutritional Risk Screening 2002 (NRS-2002), RFH-NPT, Malnutrition Universal Screening Tool(MUST), and Liver Disease Undernutrition Screening Tool (LDUST) to the patients within 24 h after admission and performed follow-up observations for 1.5 years. The RFH-NPT and NRS-2002 had higher sensitivities (64.8% and 52.4%) and specificities (60% and 70%) than the other tools with regard to screening for the malnutrition risk in cirrhotic patients. The prevalence of nutritional risk was higher under the use of RFH-NPT against the NRS-2002(63% vs. 51%). RFH-NPT tended more easily to detect the malnutrition risk in patients with advanced Child-Pugh classes (B and C) and lower MELD scores (<15) compared with NRS-2002. The RFH-NPT score was an independent predictive factor for mortality. Patients identified as being at high malnutrition risk with the RFH-NPT had a higher mortality rate than those at a low risk; the same result was not obtained with the NRS-2002. Therefore, we suggest that using RFH-NPT improves the ability of clinicians to predict malnutrition risk in patients with cirrhosis primarily caused by hepatitis virus infection at an earlier stage.

Alanine aminotransferase (ALT) flare remains one of the determinants of initiating antiviral therapy in children with chronic hepatitis B (CHB). Insufficient data exist regarding children with CHB attributed to mother‐to‐child transmission. This study aimed to assess the occurrence of spontaneous ALT flares and identify factors affecting therapy‐induced hepatitis B surface antigen (HBsAg) loss in the flare cohort. We retrospectively included untreated children with mother‐to‐child transmitted CHB. The primary outcomes were spontaneous ALT flares and therapy‐induced HBsAg loss. Among 83 untreated children, 73.5% (61/83) experienced spontaneous ALT flares during the median follow‐up of 14.6 months (range, 0.1–177.1 months), with 54.1% of the first ALT flares and 44.3% of ALT peaks occurring within 6 years of age. Thirty‐six of 61 children with ALT flares received antiviral therapy, nine (25.0%) of whom achieved therapy‐induced HBsAg loss with a median duration of 19.3 months (range, 6.5–56.2 months). The age of initiation of antiviral therapy was the sole predictor of therapy‐induced HBsAg loss (HR = 0.544, 95% CI 0.353–0.838, p = 0.006). The restricted cubic spline showed a negative relationship between the age of initiation of antiviral therapy and HBsAg loss and identified that 6.2 years of age discriminated children with therapy‐induced HBsAg loss. Kaplan–Meier estimations suggested a higher probability of HBsAg loss in children who started antiviral therapy before 6.2 years old (p = 0.03). In conclusion, asymptomatic ALT flares were frequent in preschool‐aged children with mother‐to‐child transmitted CHB, and early initiation of antiviral therapy showed promising effects in those children with ALT flares.

No abstract

Objectives This study aimed to evaluate the efficacy and safety of long-term postpartum tenofovir disoproxil fumarate (TDF) therapy in hepatitis B virus (HBV)-infected mothers with high viral load. Methods In this retrospective cohort study, HBV-infected mothers with HBV DNA>2 × 10 5 IU/mL who initiated TDF prophylaxis treatment during pregnancy were divided into TDF continuation and discontinuation groups according to whether they stopped TDF treatment within 3 months after birth or not. Virological and biochemical markers were collected before TDF treatment, antepartum and postpartum. Results In 131 women followed for a median of 18 months postpartum, alanine aminotransferase (ALT) abnormality rate was significantly lower in TDF continuation group vs. discontinuation group (39.4% vs. 56.9%, P = 0.045), and continuous TDF therapy in postpartum was independently associated with lower risk of ALT flares [OR = 0.308, 95% confidence interval (CI), 0.128-0.742; P = 0.009]. Long-term postpartum TDF treatment can promote the decline of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) levels, but the HBeAg seroconversion rate in two groups was not significant (15.5% vs. 11.7%, P = 0.541). There were no statistical differences in bone metabolism markers between two groups (P > 0.05). Compared with the TDF discontinuation group, TDF continuation group had a significantly lower estimated glomerular filtration rate level and higher creatinine level in postpartum but within normal ranges (P < 0.05). Conclusions For pregnant women who received prophylactic TDF treatment, long-term TDF therapy continued in postpartum can reduce the risk of ALT flares and promote the rapid decline of HBeAg and HBsAg levels.