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Updated: Aug 29, 2026
Real-Time Polymerase Chain Reaction-Based Detection and Quantification of Hepatitis B Virus DNA
Published on: December 15, 2023
Chronic hepatitis B: a long-term retrospective cohort study of disease progression in Shanghai, China
Biao Xu1, De-Chang Hu, Daniel M Rosenberg
1Department of Epidemiology, School of Public Health, Singapore. bxu@shmu.edu.cn
Insights
Chronic hepatitis B patients with compensated cirrhosis face significantly higher risks of decompensated cirrhosis, liver cancer, and death. Elevated alpha-fetoprotein and hepatic fibrosis severity are key prognostic factors for disease progression.
Area of Science:
- Hepatology
- Viral Hepatitis
- Oncology
Background:
- Chronic hepatitis B (CHB) is a significant global health concern.
- Understanding disease progression in CHB patients is crucial for effective management.
- Compensated cirrhosis is an intermediate stage that may precede decompensation.
Purpose of the Study:
- To describe CHB disease progression in Shanghai, China.
- To estimate risks of decompensated cirrhosis, hepatocellular carcinoma (HCC), and death.
- To identify prognostic factors for CHB disease progression.
Main Methods:
- Retrospective analysis of 322 biopsy-confirmed CHB cases diagnosed 1981-1993.
- Longitudinal follow-up until 1999-2000 with clinical and laboratory assessments.
- Statistical analyses including incidence rates, Kaplan-Meier, log-rank, and Cox regression.
Main Results:
- Incidence rates per 1000 person-years: decompensated cirrhosis (6.3 vs 35.6), HCC (2.8 vs 8.2), death (7.6 vs 35.2) for non-compensated vs compensated cirrhosis.
- 15-year survival rates: 88% (non-compensated) vs 56% (compensated) (P < 0.001).
- Risk factors for decompensation/death: elevated alpha-fetoprotein (AFP), gamma-globulin, and hepatic fibrosis severity.
Conclusions:
- Baseline elevated AFP and hepatic fibrosis severity predict higher risks of decompensated cirrhosis and death in CHB patients.
- Compensated cirrhosis significantly increases long-term negative outcomes.
- Provides valuable long-term outcome data for CHB patients in Shanghai.
Background And Aims:
The present study aimed to describe the disease progression of chronic hepatitis B patients without or with compensated cirrhosis at baseline, to estimate the risk of progression to decompensated cirrhosis, hepatocellular carcinoma and death, and to determine prognostic factors of disease progression in patients in Shanghai, China.
Methods:
Stored medical records from 322 biopsy-confirmed chronic hepatitis B cases diagnosed between 1981 and 1993 were selected, and the status of patients was tracked in 1999-2000. Among consenting patients, ultrasound examination and laboratory tests were conducted. Person-year incidence rates, Kaplan-Meier analysis, log-rank tests, and Cox regression analysis were conducted.
Results:
Among chronic hepatitis B patients without compensated cirrhosis, the incidence rates of decompensated cirrhosis, hepatocellular carcinoma, and death were 6.3, 2.8, and 7.6 per 1000 person-years, respectively, while for patients with compensated cirrhosis, the rates were 35.6, 8.2, and 35.2 per 1000 person-years, respectively. The 15-year survival rate was 88% for patients without compensated cirrhosis, compared with 56% for patients with compensated cirrhosis (P < 0.001). Cox regression analysis demonstrated that increased alpha-fetoprotein (AFP) (P < 0.01), gamma-globulin (P < 0.05), and high-level severity of hepatic fibrosis (P < 0.01) at baseline were risk factors of decompensated cirrhosis. Factors associated with a high risk of death included elevated AFP at baseline (P < 0.01), severity of hepatic fibrosis (P < 0.003), and sustained positivity for hepatitis B surface antigen (P < 0.004).
Conclusion:
Increased AFP and severity of hepatic fibrosis at baseline were associated with higher risk of decompensated cirrhosis and death. These data provide rare empirical estimates of the negative long-term outcomes for patients with chronic hepatitis B in Shanghai, China.
