Clin Gastroenterol Hepatol. 2020 Jan 23. pii: S1542-3565(20)30097-5. doi: 10.1016/j.cgh.2020.01.018. [Epub ahead of print]
Hepatitis flare-related decompensation is associated with better outcomes in patients with chronic hepatitis B.
Chang ML1, Cheng JS2, Chien RN3, Liaw YF3.
Author information
1
Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: [email protected].
2
Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
3
Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Abstract
BACKGROUND & AIMS:
The effects of baseline hepatitis flares (alanine transaminase level >5 times the upper limit of normal) on the outcomes of cirrhotic chronic hepatitis B (CHB) patients with decompensation treated with nucleos(t)ide analogues (Nucs) remain elusive; thus, we aimed to investigate these effects.
METHODS:
This 16-year cohort study monitored 511 consecutive cirrhotic CHB patients treated with Nucs for decompensation.
RESULTS:
Of the 511 patients, 399 (78.1%) were males, and 300 (58.7%) had baseline flares. Patients with flares had higher baseline levels of hepatitis B virus (HBV) DNA (6.44±1.52 vs. 6.08±1.46 log10 IU/mL, p=0.003), quantitative hepatitis B surface antigen, total bilirubin (bili-t), prolonged prothrombin time (δPT), platelet counts (108.0±42.9 vs. 83.6±44.7 103/μL, p<0.001) and genotype B infection rates but lower neutrophil-to-lymphocyte ratios (NLRs) (6.14±9.18 vs. 9.12±1.36, p=0.019), rates of hepatitis B e antigen positivity, ascites, esophageal varices (EVs), and splenomegaly and cumulative incidence of mortality or liver transplantation (46.5 vs. 73.2%, p<0.001) than the patients without flares despite their similar short-term (<3 months) outcomes. EVs [95% confidence interval (CI) of odds ratio: 0.067-0.406], ascites (0.178-0.969), levels of bili-t (1.041-1.269) and δPT (1.033-1.168) and platelet counts (1.00-1.018) were independently associated with baseline flares. After matching patients with and without baseline flares through propensity score matching method, flares (95% CI hazard ratio: 0.317-0.76) and levels of NLR (1.027-1.591) and δPT (1.052-1.423) were independently associated with the cumulative incidence of mortality or liver transplantation.
CONCLUSIONS:
In decompensated, cirrhotic CHB patients treated with Nucs, a baseline hepatitis flare was independently associated with favorable long-term (>3 months) outcomes.