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Factors predictive of liver cirrhosis in patients with chronic hepatitis B: a multivariate analysis in a longitudinal
1Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan, Republic of China. tihuo@vghtpe.gov.tw
Insights
Elderly, male, diabetic patients, or those with severe persistent hepatitis face higher cirrhosis risk from chronic hepatitis B (HBV). Close monitoring and antiviral therapy are recommended for these high-risk individuals.
Area of Science:
- Hepatology
- Viral Hepatitis
- Gastroenterology
Background:
- Chronic hepatitis B virus (HBV) infection is a leading cause of liver cirrhosis.
- Factors influencing cirrhosis development in HBV patients require further elucidation.
Purpose of the Study:
- To identify independent risk factors for cirrhosis development in patients with chronic hepatitis B.
- To estimate the probability of cirrhosis occurrence based on identified risk factors.
Main Methods:
- Longitudinal follow-up of 516 chronic hepatitis B patients.
- Multivariate analysis to determine independent risk factors for cirrhosis.
- Logistic regression to predict cirrhosis probability.
Main Results:
- Annual cirrhosis incidence was 2.4% over a mean 5.7-year follow-up.
- Independent risk factors included older age (>45), male gender, persistent hepatitis, and diabetes mellitus.
- Higher initial necro-inflammatory scores were observed in patients who developed cirrhosis.
Conclusions:
- Elderly, male, diabetic patients, and those with severe persistent hepatitis are at increased risk.
- These high-risk individuals warrant close monitoring for HBV-related complications.
- Aggressive antiviral therapy may be beneficial for patients with identified risk factors.
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.