Influential factors of prognosis in lamivudine treatment for patients with acute-on-chronic hepatitis B liver failure

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J Gastroenterol Hepatol. 2009 Nov 24. [Epub ahead of print]

Influential factors of prognosis in lamivudine treatment for patients with

acute-on-chronic hepatitis B liver failure

Sun LJ, Yu JW, Zhao YH, Kang P, Li SC.

Department of Infectious Diseases, Second Affiliated Hospital, Harbin Medical

University, Harbin, China.

Abstract

Background and Aims: Chronic hepatitis B virus (HBV) infection is a major global

health issue, and the prognosis of patients with HBV-associated acute-on-chronic

hepatic failure (ACLF) is extremely poor. In this study, the efficacy of

lamivudine was investigated in patients with ACLF. The effects of HBV DNA load

and its related factors on the prognosis were also further explored. Methods: A

matched retrospective cohort study using data on ACLF patients derived from our

hospital database was conducted. One hundred and thirty patients receiving

lamivudine were selected into the lamivudine treatment group with another 130

without lamivudine treatment studied as control. They were matched for sex, age

and imaging finding with the lamivudine treatment group. All the patients were

followed up for 3 months and the survival rates were compared. The influential

factors on the mortality were studied by the proportional hazards model.

Results: The cumulative survival rates of patients in the lamivudine group were

higher than those of the control group (chi(2) = 9.50, P = 0.0021). The

mortality of patients in the high virus load group (71/95, 74.7%) was higher

than that of those in the low virus load group (15/29, 51.7%) (chi(2) = 5.536, P

= 0.019). For patients with a Model for End-Stage Liver Disease (MELD) score of

20-30 by week 4, the mortality of those with HBV DNA that was undetectable or

declined for more than 2 log(10) (2/12, 16.7%; 18/40, 45.0%) was lower than that

of those with a less than 2 log(10) decline (18/23, 78.3%) (chi(2) = 10.106, P =

0.001). In the proportional hazards model, for patients with a MELD score of

20-30, treatment method (P = 0.002), pretreatment HBV DNA load (P = 0.007) and

decline of HBV DNA load during therapy (P = 0.003) were independent predictors;

for those with a MELD score of above 30, MELD score (P = 0.008) was the only

independent predictor. Conclusion: Lamivudine can significantly decrease the

3-month mortality of patients with a MELD score of 20-30, and a low pretreatment

viral load and rapid decline of HBV DNA load are good predictors for the outcome

of the treatment.

PMID: 19968744 [PubMed - as supplied by publisher]