Pretreatment HBsAg level and an early decrease in MELD score predict prognosis to lamivudine treatment for...

Area of Science:

• Hepatology
• Virology
• Clinical Medicine

Background:

• Limited data exist on predicting nucleos(t)ide analogue treatment response in acute-on-chronic liver failure (ACLF).
• Hepatitis B surface antigen (HBsAg) quantification's predictive value in ACLF requires further investigation.

Purpose of the Study:

• To assess HBsAg levels and Model for End-Stage Liver Disease (MELD) scores for predicting prognosis in HBeAg-negative ACLF patients receiving lamivudine monotherapy.
• To analyze the combined predictive power of HBsAg and MELD scores for treatment outcomes.

Main Methods:

• Fifty-seven nucleoside-naïve, HBeAg-negative ACLF patients received daily lamivudine (100mg).
• Serum HBsAg, HBV DNA, and biochemical markers were measured at baseline and month 3 or before death.
• MELD scores were calculated, and 3-month mortality was analyzed.

Main Results:

• HBV DNA decreased, but HBsAg levels remained unchanged post-treatment.
• Patients who survived had significantly higher HBsAg levels and lower MELD scores than non-survivors.
• Higher pretreatment HBsAg levels (>4000 COI) correlated with lower post-treatment MELD scores and reduced 3-month mortality.

Conclusions:

• Higher pretreatment HBsAg levels are associated with better outcomes in HBeAg-negative ACLF patients treated with lamivudine.
• An early decrease in MELD score during lamivudine therapy indicates a lower 3-month mortality risk.