Poor Outcomes for Severe Exacerbation of HBV

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[B]Study Identifies Predictors of Poor Outcomes in Patients with Severe Exacerbation of HBV[/B]

By Brian Boyle, MD
An exacerbation of chronic HBV infection occurs in up to 50% of patients that are hepatitis B e antigen (HBeAg)–positive and up to 30% of those who test positive for antibodies against HBeAg (anti-HBe).

These exacerbations are usually transient and asymptomatic; however, a small percentage of patients will have a severe exacerbation and progress to severe hepatic decompensation and death. To this point, there are only limited data available to help clinicians stratify the risk for a poor outcome among patients who have a severe exacerbation of their HBV infection.

In a study published in Clinical Infectious Diseases, 47 patients with severe HBV exacerbation were compared with 96 who had mild exacerbation and 96 who had no exacerbation.

Of the 47 patients with a severe exacerbation, 15 died and 2 underwent liver transplantation. Preexisting cirrhosis and a prothrombin time (PT) of >30 seconds were present in 60.9% and 87.5%, respectively, of patients with adverse outcomes during their severe exacerbation.

The rate of adverse outcomes increased to 92.3% when albumin levels of ≤35 grams/liter and bilirubin levels of >200 micromolars were also present. Other factors associated with adverse outcomes included the patient’s peak bilirubin level, peak PT, time to reach peak PT, and the presence of encephalopathy and/or ascites. There was no difference in the frequency of precore mutations in patients with severe or mild exacerbation or without exacerbation.

The authors conclude, “several risk factors at presentation and during subsequent monitoring have been identified as indicators of poor prognosis for exacerbation of HBV infection. These factors could be useful in deciding whether early liver transplantation is warranted.”

04/16/03

Reference
M-F Yuen and others. Prognostic Factors in Severe Exacerbation of Chronic Hepatitis B. Clinical Infectious Diseases 2003; 36:979–84.