http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10912490&dopt=Abstract
Factors predictive of liver cirrhosis in patients with
chronic hepatitis B: a multivariate analysis in a longitudinal study.
Huo T, Wu JC, Hwang SJ, Lai CR, Lee PC, Tsay SH, Chang FY, Lee SD.
Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming
University School of Medicine, Taiwan, Republic of China. tihuo@vghtpe.gov.tw
OBJECTIVE AND DESIGN: Chronic hepatitis
B virus (HBV) infection may lead to liver cirrhosis; however, factors associated
with the development of cirrhosis have been incompletely studied. A total
of 516 patients with chronic hepatitis B were followed up longitudinally to
determine their outcome. METHODS: The clinical and pathological features were
compared between those with and without cirrhosis occurrence. The risk factors
were analysed, and the probability of the development of cirrhosis was
estimated. RESULTS: During a mean follow-up period of 5.7 +/- 3.4 years (range
1-17 years), cirrhosis occurred in 71 patients, with a calculated annual
incidence of 2.4%. Older age (> 45 years) at entry, male gender,
persistent hepatitis (> 1.5-fold rise of serum
alanine
aminotransferase
levels for at least one year) and diabetes mellitus were identified as
independent risk factors of cirrhosis in a multivariate analysis (odds ratios
8.0, 19.3, 2.0 and 5.2, respectively; P values all < 0.05). A logistic
regression equation was used to predict the probability of cirrhosis occurrence,
which was as high as 76.6% when all risk factors were present. Acute
exacerbation or super-infection by hepatitis C or D viruses were not significant
predictors. Patients with subsequent cirrhosis had higher initial hepatic
histological necro-inflammatory activities when compared to age- and sex-matched
non-cirrhotic controls (Knodell's scores: 8.2 +/- 2.4 versus 6.0 +/- 4.1, P<
0.05). CoNCLUSIONS: Patients who were
elderly, male, diabetic or had a history of persistent and
histologically
severe hepatitis were at increased risks of liver cirrhosis. Aggressive
anti-viral therapy may be needed for these patients and they should be closely
monitored for HBV-related late complications.
PMID: 10912490 [PubMed - indexed for MEDLINE]
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