[A retrospective cohort study on the natural history of chronic hepatitis Beta in Shanghai, China]
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Published on: February 19, 2019
Biao Xu1, Dechang Hu, Rosenberg Daniel
1Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.
Insights
Patients with chronic hepatitis B (CHB) and compensated cirrhosis face significantly lower survival rates and higher risks of decompensated cirrhosis compared to those without cirrhosis. Both groups exhibit elevated mortality risks from liver cancer and hepatic diseases.
Area of Science:
- Hepatology
- Viral Hepatitis
- Clinical Epidemiology
Context:
- Chronic hepatitis B (CHB) is a significant global health concern.
- Understanding the long-term prognosis of CHB is crucial for patient management.
- Previous studies on CHB natural history in China are limited.
Purpose:
- To describe the natural history of chronic hepatitis B (CHB) in Shanghai, China.
- To compare survival rates and disease progression between CHB patients with and without cirrhosis.
Summary:
- A retrospective study of 322 biopsy-proven CHB patients (1981-1993) analyzed survival, decompensated cirrhosis, and hepatocellular carcinoma incidence.
- CHB patients with compensated cirrhosis had significantly lower survival rates (5-year: 85.3%) and higher incidence of decompensated cirrhosis (35.6/1000 person-year) compared to those without cirrhosis (5-year survival: 95.9%).
- Both groups showed markedly high standardized mortality ratios (SMRs) for total death, liver cancer, and hepatic diseases, indicating a substantial long-term risk.
Impact:
- This study highlights the critical impact of cirrhosis on CHB prognosis.
- Findings emphasize the need for vigilant monitoring and management of CHB patients, especially those with cirrhosis.
- The results provide valuable data for public health strategies and clinical guidelines for CHB in China.
Objective:
To describe the natural history of chronic hepatitis Beta in patients with chronic hepatitis Beta (CHB) in Shanghai, China.
Methods:
322 cases with biopsy-proven CHB diagnosed from 1981 to 1993 were retrospectively studied. Medical records since the original diagnosis were reviewed and final examination was performed on those who were still living. Survival analysis including life table, Kaplan-Meier method and Log-Rank test was applied to compare the survival rates, and un-happen rates of decompensated cirrhosis and hepatocellular carcinoma between the groups with compensated cirrhosis and without cirrhosis at the original diagnosis. Standardized mortality ratio (SMR) was calculated to reflect the death risks from total death, hepatic disease death and liver cancer death.
Results:
For CHB without cirrhosis group, the incidence of decompensated cirrhosis and hepatocellular carcinoma were 6.7 per thousand person-year and 2.8 per thousand person-year,respectively. The mortality was 7.6 per thousand person-year. The 5-, 10-, 15- year survival rates were 95.9%, 93.0% and 87.9%, respectively. The 5-, 10-, 15-year decompensated cirrhosis un-happen rates were 97.1%, 95.4% and 88.9%, respectively. The SMRs of total death, liver cancer death and hepatic diseases death were 2.50, 9.73 and 80.38, respectively. For CHB with compensated cirrhosis group, the incidence of decompensated cirrhosis and hepatocellular carcinoma were 35.6 per thousand person-year and 8.2 per thousand person-year, respectively. The mortality was 35.2 per thousand person-year. The 5-, 10-, 15- year survival rates were 85.3%, 69.0% and 55.8%, respectively. The 5-, 10-, 15-year decompensated cirrhosis un-happen rates were 82.0%, 63.8%, and 58.7%, respectively. The SMRs of total death, liver cancer death and hepatic diseases death were 8.09, 30.30 and 312.50, respectively.
Conclusions:
CHB with compensated cirrhosis group had a significantly lower survival rates and lower un-happen rates of decompensated cirrhosis as compared with CHB without cirrho s is group through Log-Rank tests. Both groups had remarkable high SMRs of total death, liver cancer death and hepatic disease death.
