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Gastroenterol Hepatol. 2017 Dec 23. pii: S0210-5705(17)30243-1. doi: 10.1016/j.gastrohep.2017.11.003. [Epub ahead of print]
Hepatitis B virus e antigen-negative chronic infection. Treatment based on glutamic pyruvic transaminase and hepatitis B virus deoxyribonucleic acid cut-off values. [Article in English, Spanish]
Guardiola-Arévalo A1, Gómez Rodríguez R2, Romero Gutiérrez M2, Gómez Moreno AZ3, García Vela A3, Sánchez Simón R4, Gómez Hernando C5, Andrés Esteban EM6.
Author information
1Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Toledo, España; Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España. Electronic address: [email protected].2Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Toledo, España.3Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.4Servicio de Anatomía Patológica, Hospital Virgen de la Salud, Toledo, España.5Servicio de Microbiología, Hospital Virgen de la Salud, Toledo, España.6Universidad Jaume I, Castellón, España.
AbstractOBJECTIVES: To identify glutamic pyruvic transaminase (GPT) and hepatitis B virus DNA (HBV-DNA) cut-off values at diagnosis in patients with hepatitis B virus e antigen-negative chronic infection (HBeAg(-)), which may be predictors of clinical course, prognosis and/or the need for antiviral therapy.
METHODS: A retrospective and observational cohort study of patients diagnosed with HBeAg(-) chronic infection (2005-2012). A normal GPT cut-off value at diagnosis that predicts abnormal GPT values in the clinical course of the infection, a baseline HBV-DNA cut-off value that predicts an increase in HBV-DNA above 2,000IU/ml, and GPT and HBV-DNA as predictors of the need for treatment were investigated using ROC curves.
RESULTS: 126 patients were enrolled (follow-up: 42.1±21.5months), 93 of which had normal GPT levels at diagnosis. In the ROC curve analysis, 900IU/ml was found to be the HBV-DNA cut-off value that best predicted this value's increase above 2,000IU/ml (sensitivity: 90%; specificity: 88%; PPV: 79%; NPV: 100%; diagnostic precision: 89%), while 25mU/ml was the normal GPT cut-off value at diagnosis that best predicted subsequently elevated GPT levels (sensitivity: 95.4%; specificity: 81.6%; PPV: 67%; NPV: 96%; diagnostic precision: 80.6%). Patients with GPT 26-40mU/ml at diagnosis presented with more complications or required more treatment than subjects with GPT≤25mU/ml (P<.05). The combined GPT and HBV-DNA values that elicited the highest treatment need were 38mU/ml of GPT and 6,000IU/ml of HBV-DNA (sensitivity: 75%; specificity: 93.4%; PPV: 60%; NPV: 96.6%).
CONCLUSION: HBeAg(-) patients with GPT<25mU/ml and HBV-DNA<900IU/ml at diagnosis have positive outcomes and may not require such stringent follow-up in the first years after diagnosis.
Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
KEYWORDS: Antígeno e de la hepatitis B ;Hepatitis B crónica; Deoxyribonucleic acid; Glutamate pyruvate transaminase (GPT); Glutámico-pirúvica transaminasa (GPT); Hepatitis B e antigen; Hepatitis B virus; Hepatitis B, Chronic; Virus de la hepatitis B; Ácido desoxirribonucleico
PMID:29279233DOI:10.1016/j.gastrohep.2017.11.003
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