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

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

doi:10.1007/s00535-012-0561-8

Cited by 24 publications

(26 citation statements)

References 46 publications

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“…20 The occurrence of EESAT in patients with CHB should raise concern, as it appears to be associated with a poor outcome. 21,22 Indeed, two of the three died from fulminant hepatic failure within days of the onset of EESAT. It is thus important for clinicians to make an early diagnosis of the reactivation of CHB in a patient presenting with ALT >3000 U/L, as this may necessitate early referral for liver transplantation in view of the consequent rapid deterioration and high mortality.…”

Section: Discussionmentioning

confidence: 99%

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Low serum albumin and advanced age predict early mortality in Asian patients with extreme elevations of serum aminotransferase

Chang

Goh

Tan

2016

J of Digest Diseases

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Section: Discussionmentioning

confidence: 99%

“…However, it is uncommon for the reactivation of CHB to develop extreme transaminitis beyond 3000 U/L . The occurrence of EESAT in patients with CHB should raise concern, as it appears to be associated with a poor outcome . Indeed, two of the three died from fulminant hepatic failure within days of the onset of EESAT.…”

Section: Discussionmentioning

confidence: 99%

Low serum albumin and advanced age predict early mortality in Asian patients with extreme elevations of serum aminotransferase

Chang

Goh

Tan

2016

J of Digest Diseases

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“…Additionally, we recently reported that the introduction of high‐dose CS in the early stage of viral ALF suppressed the destruction of hepatocytes . In another study from Japan evaluating the predictors of progression to hepatic decompensation during severe acute exacerbation of CHB, the authors concluded that antiviral therapies with CS should be started as soon as possible in cases with high T‐Bil level and/or low PT levels . Moreover, in a recent meta‐analysis evaluating the safety, efficacy and side effects of glucocorticoid therapy for severe viral hepatitis B, treatment with glucocorticoids significantly increased the survival rate of patients with severe viral hepatitis B .…”

Section: Discussionmentioning

confidence: 99%

Virological efficacy of combination therapy with corticosteroid and nucleoside analogue for severe acute exacerbation of chronic hepatitis B

Yasui

Fujiwara

Nakamura

et al. 2014

Journal of Viral Hepatitis

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The short-term prognosis of patients with severe acute exacerbation of chronic hepatitis B (CHB) leading to acute liver failure is extremely poor. We have reported the efficacy of corticosteroid in combination with nucleoside analogue in the early stages, but virological efficacy has not been documented. Our aim was to elucidate the virological efficacy of this approach. Thirteen patients defined as severe acute exacerbation of CHB by our uniform criteria were prospectively examined for virological responses to treatment. Nucleoside analogue and sufficient dose of corticosteroids were introduced as soon as possible after the diagnosis of severe disease. Of the 13 patients, 7 (54%) survived, 5 (38%) died and 1 (8%) received liver transplantation. The decline of HBV DNA was significant between the first 2 weeks (P = 0.02) and 4 weeks (P < 0.01). Mean reduction in HBV DNA during the first 2 weeks was 1.7 ± 0.9 log copies per mL in overall patients, 2.1 ± 0.8 in survived patients and 1.2 ± 0.9 in dead/transplanted patients. The decline of HBV DNA was significant between the first 2 weeks (P = 0.03) and 4 weeks (P = 0.02) in survived patients, but not in dead/transplanted patients. Our study shows that corticosteroid treatment in combination with nucleotide analogue has sufficient virological effect against severe acute exacerbation of CHB, and a rapid decline of HBV DNA is conspicuous in survived patients.

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“…During AE of HBeAg-positive CHB, serum HBV DNA cut-off value of 1.55 × 10 9 copies/mL can predict decompensation and be used to identify patients in need of immediate antiviral therapy [29]. Serum bilirubin (>5 mg/dl) was identified as a significant determinant of progression to liver failure and prothrombin activity (<45%) as a determinant of liver related death [30]. Low PLT (≤143 × 10 9 /L) and high serum bilirubin (>172 mmol/L) was also reported to be the only independent factors of mortality [17].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Nucleos(t)ide Analogues in Patients with Spontaneous Acute Exacerbation of Chronic Hepatitis B: A Systematic Review and Meta-Analysis

Zhao

Shen

et al. 2013

PLoS ONE

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BackgroundSpontaneous acute exacerbation (AE) of chronic hepatitis B (CHB) is often detrimental but sometimes leads to sustained immune control and disease remission. The efficacy and safety of nucleos(t)ide analogues (NAs) in patients with spontaneous AE of CHB remains unclear.MethodsWe performed a systematic review and meta-analysis of NAs in patients with spontaneous AE of CHB. We calculated pooled effects of NAs in these patients of each study and conducted quantitative meta-analysis, displaying results using Forest plots.Results15 studies were included and substantial heterogeneity was noted in the inclusion/exclusion criteria and controls. Pooled data showed no benefit of lamivudine (LAM) vs. untreated controls for transplant-free survival in patients with spontaneous AE of CHB (OR = 0.98 (95% CI, 0.50–1.92; P = 0.956)), hepatic decompensation (OR = 0.94 (95% CI, 0.47–1.88; P = 0.862)) and liver failure owing to AE (OR = 2.30 (95% CI, 0.35–15.37; P = 0.387)) at 3 months. Entecavir achieved even higher short-term mortality than LAM. NAs led to rates of ALT normalization, undetectable HBV DNA, HBeAg loss, HBeAg seroconversion and drug resistance at 1 year in 88%, 61%, 46%, 35% and 5%. Pooled data also showed benefit favoring LAM vs. untreated controls for ALT normalization (OR = 1.98 (95% CI, 1.03–3.80; P = 0.039)) and undetectable HBV DNA (OR = 38.50 (95% CI, 7.68–192.99; P<0.001)) at 3 months. All NAs were relatively safe and well tolerated.ConclusionNAs had no obvious impact on short-term survival in patients with AE of CHB, despite of possible better antiviral responses. We suggest additional studies to evaluate the efficacy of other NAs and early introduction of immunosuppressant in combination with NAs. We highlight developing prognostic models to identify predictors of mortality and disease progression for AE of CHB.

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

Cited by 24 publications

References 46 publications

Low serum albumin and advanced age predict early mortality in Asian patients with extreme elevations of serum aminotransferase

Low serum albumin and advanced age predict early mortality in Asian patients with extreme elevations of serum aminotransferase

Virological efficacy of combination therapy with corticosteroid and nucleoside analogue for severe acute exacerbation of chronic hepatitis B

The Efficacy and Safety of Nucleos(t)ide Analogues in Patients with Spontaneous Acute Exacerbation of Chronic Hepatitis B: A Systematic Review and Meta-Analysis

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