1. Differentiation of acute and chronic hepatitis B in IgM anti-HBc positive patients.
- Author
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Park JW, Kwak KM, Kim SE, Jang MK, Kim DJ, Lee MS, Kim HS, and Park CK
- Subjects
- Acute Disease, Adult, Area Under Curve, Biomarkers blood, Chi-Square Distribution, DNA, Viral blood, Diagnosis, Differential, Disease Progression, Female, Hepatitis B blood, Hepatitis B genetics, Hepatitis B immunology, Hepatitis B, Chronic blood, Hepatitis B, Chronic immunology, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, ROC Curve, Retrospective Studies, Risk Factors, Viral Load, Hepatitis B diagnosis, Hepatitis B Antibodies blood, Hepatitis B, Chronic diagnosis, Immunoglobulin M blood
- Abstract
Aim: To identify the factors that differentiate acute hepatitis B (AHB) from chronic hepatitis B with acute exacerbation (CHB-AE)., Methods: From 2004 to 2013, a total of 82 patients (male n = 52, 63.4%; female n = 30, 36.6%) with clinical features of acute hepatitis with immunoglobulin M antibodies to the hepatitis B core antigen (IgM anti-HBc) were retrospectively enrolled and divided into two groups; AHB (n = 53) and CHB-AE (n = 29). The AHB group was defined as patients without a history of hepatitis B virus (HBV) infection before the episode and with loss of hepatitis B surface antigen within 6 mo after onset of acute hepatitis. Biochemical and virological profiles and the sample/cutoff (S/CO) ratio of IgM anti-HBc were compared to determine the differential diagnostic factors., Results: The multivariate analysis demonstrated that, the S/CO ratio of IgM anti-HBc and HBV DNA levels were meaningful factors. The S/CO ratio of IgM anti-HBc was significantly higher in the AHB group, while the HBV DNA level was significantly higher in the CHB-AE group. The optimal cutoff values of IgM anti-HBc and HBV DNA levels for differentiating the two conditions were 8 S/CO ratio and 5.5 log₁₀ IU/mL, respectively. The sensitivity and specificity were 96.2% and 89.7% for the S/CO ratio of IgM anti-HBc and 81.1% and 72.4% for HBV DNA levels, respectively. The area under receiver operating characteristic curves of both the S/CO ratio of IgM anti-HBc and HBV DNA levels were not significantly different (0.933 vs 0.844, P = 0.105). When combining IgM anti-HBc and HBV DNA, the diagnostic power significantly improved compared to HBV DNA alone (P = 0.0056). The combination of these factors yielded a sensitivity and specificity of 98.1% and 86.2%, respectively., Conclusion: The combination of the S/CO ratio of IgM anti-HBc and HBV DNA levels was a useful tool for differentiating AHB from CHB-AE in patients with positive IgM anti-HBc.
- Published
- 2015
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