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

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http://www3.interscience.wiley.com/journal/123190416/abstract

Journal of Gastroenterology and Hepatology

Early View (Articles online in advance of print)

Published Online: 24 Nov 2009

Journal compilation © 2010 Blackwell Publishing Asia Pty Ltd and Journal of

Gastroenterology and Hepatology Foundation

HEPATOLOGY

Influential factors of prognosis in lamivudine treatment for patients with

acute-on-chronic hepatitis B liver failure

Li-Jie Sun, Jian-Wu Yu, Yong-Hua Zhao, Peng Kang and Shu-Chen Li

Department of Infectious Diseases, Second Affiliated Hospital, Harbin Medical

University, Harbin, China

Correspondence to Jian-Wu Yu, Department of infectious diseases, Second

Affiliated Hospital, Harbin Medical University, 246 Xuefu Road, Nangang

District, Harbin 150086, China. Email: yujianwu45@...

Copyright Journal compilation © 2009 Blackwell Publishing Asia Pty Ltd and

Journal of Gastroenterology and Hepatology Foundation

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 (÷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%) (÷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 log10 (2/12, 16.7%; 18/40, 45.0%) was lower than that of those with

a less than 2 log10 decline (18/23, 78.3%) (÷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.

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Accepted for publication 5 August 2009.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1440-1746.2009.06089