Approach to the patient with chronic hepatitis B and decompensated cirrhosis

Abstract

Patients with chronic hepatitis B virus (HBV) can develop progressive fibrosis, cirrhosis and hepatocellular carcinoma. Patients with chronic HBV and cirrhosis are at risk of developing hepatic decompensation and have high mortality without antiviral therapy and/or liver transplantation. Treatment of chronic HBV with antiviral therapy is indicated in all patients with cirrhosis whatever the HBe‐antigen status and serum alanine aminotransferase (ALT), so that hepatic decompensation can be prevented. Initiating antiviral therapy in patients with decompensated cirrhosis can improve liver function, Child‐Turcotte‐Pugh (CTP) and model for end‐stage liver disease (MELD) scores, as well as the need for liver transplantation and mortality. Patients with chronic HBV and cirrhosis who do not respond to antiviral therapy with normalization of ALT may have a co‐existent liver disorder. One of the most common co‐existent liver disorders present in patients with chronic HBV is non‐alcoholic fatty liver disease (NAFLD). Patients with chronic HBV, NAFLD and cirrhosis may be at risk of developing decompensated cirrhosis and require a liver transplant. If patients with chronic HBV require liver transplantation, infection of the liver graft with HBV can be prevented with antiviral therapy.

Liver-to-Spleen Volume Ratio Automatically Measured on CT Predicts Decompensation in Patients with B Viral Compensated Cirrhosis

“…The date of CT acquisition was taken as the date of inclusion and was defined as the baseline. The baseline demographic characteristics and laboratory parameters that could potentially be associated with the prognosis of HBV cirrhosis [ 16 17 18 ], including AST, alanine aminotransferase (ALT), bilirubin, albumin, PT INR, platelets, creatinine, HBV e antigen (HBeAg), and serum HBV deoxyribonucleic acid (DNA), were recorded. The serum HBV DNA level was quantified using a polymerase chain reaction-based test (Abbott real-time HBV kit, Abbott) and categorized as ≤ 2000 IU/mL, 2000–200000 IU/mL, or > 200000 IU/mL [ 16 ].…”

“…Chronic hepatitis B viral (HBV) infection is a leading cause of liver cirrhosis [ 15 ]. The progression of HBV cirrhosis is dependent on active viral replication, the use of antiviral therapy, and the degree of pre-existing liver damage and remnant liver function [ 16 17 18 ]. We hypothesized that LSVR, which potentially reflects portal hypertension, is a prognostic predictor in patients with HBV-compensated cirrhosis.…”

Application of Health Education Model Based on Theory of Behavior Change in Nursing Care of Patients with Chronic Hepatitis B

“…And these factors can induce a variety of psychological stress reactions, leading to a decrease in patients' hope level and negative treatment of the disease and treatment [12]. Therefore, in the long-term treatment of CHB, it is of great significance to promote the patients to develop self-management behavior ability, help them to correctly understand the disease, and maintain good compliance with the doctor's advice [13].…”

Increased Serum Levels of sCD206 Are Associated with Adverse Prognosis in Patients with HBV-Related Decompensated Cirrhosis

“…The median survival time drops from more than 12 years for the compensated state to approximately 2 years for the decompensated state due to these events [ 5 ]. The only curative therapy for DeCi is liver transplantation [ 6 ]. However, the shortage of inadequate social support and donor livers has limited the clinical application of liver transplantation.…”