long-term retrospective cohort study of disease

liver411

Journal of Gastroenterology and Hepatology
Volume 18 Issue 12 Page 1345  - December 2003
doi:10.1046/j.1440-1746.2003.03187.x


Chronic hepatitis B: A long-term retrospective cohort study of disease
progression in Shanghai, China

BIAO XU*, DE-CHANG HU, DANIEL M ROSENBERG, QING-WU JIANG*, XI-MIN LIN*,
JIA-LIANG LU* AND NOAH J ROBINSON§

Abstract

Background and Aims: The present study aimed to describe the disease
progression of chronic hepatitis B patients without or with compensated
cirrhosis at baseline, to estimate the risk of progression to decompensated
cirrhosis, hepatocellular carcinoma and death, and to determine prognostic
factors of disease progression in patients in Shanghai, China.

Methods: Stored medical records from 322 biopsy-confirmed chronic hepatitis
B cases diagnosed between 1981 and 1993 were selected, and the status of
patients was tracked in 1999-2000. Among consenting patients, ultrasound
examination and laboratory tests were conducted. Person-year incidence
rates, Kaplan-Meier analysis, log-rank tests, and Cox regression analysis
were conducted.

Results: Among chronic hepatitis B patients without compensated cirrhosis,
the incidence rates of decompensated cirrhosis, hepatocellular carcinoma,
and death were 6.3, 2.8, and 7.6 per 1000 person-years, respectively, while
for patients with compensated cirrhosis, the rates were 35.6, 8.2, and 35.2
per 1000 person-years, respectively. The 15-year survival rate was 88% for
patients without compensated cirrhosis, compared with 56% for patients with
compensated cirrhosis (P < 0.001). Cox regression analysis demonstrated that
increased -fetoprotein (AFP) (P < 0.01), -globulin (P < 0.05), and
high-level severity of hepatic fibrosis (P < 0.01) at baseline were risk
factors of decompensated cirrhosis. Factors associated with a high risk of
death included elevated AFP at baseline (P < 0.01), severity of hepatic
fibrosis (P < 0.003), and sustained positivity for hepatitis B surface
antigen (P < 0.004).

Conclusion: Increased AFP and severity of hepatic fibrosis at baseline were
associated with higher risk of decompensated cirrhosis and death. These data
provide rare empirical estimates of the negative long-term outcomes for
patients with chronic hepatitis B in Shanghai, China.