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Fulminant hepatitis B is a clinical syndrome that results from massive necrosis of liver cells leading to the development of hepatic encephalopathy. The aim of this study was to evaluate the efficacy of lamivudine in patients with fulminant hepatitis B and study the prognostic factors. A matched retrospective cohort study using data on fulminant hepatitis B patients derived from our hospital database was conducted. Forty patients receiving lamivudine treatment were selected into the lamivudine treatment group with another 40 without lamivudine treatment studied as control. They were matched for sex, age and HBeAg status with lamivudine treatment group. The mortality of patients in two groups was compared. The influential factors on the mortality were studied by Cox proportional hazards model. The mortality of patients in the lamivudine group ( n=38) was significantly lower than that of the control group ( n=39) (63.2 vs. 84.6%; χ=4.609, P=0.032). For patients without systemic inflammatory response syndrome (SIRS), the mortality of patients in the lamivudine group ( n=25) was significantly lower than that of the control group ( n=26) (52.0 vs. 80.8%; χ=4.747, P=0.029). In multivariate Cox proportional hazards analyses, for patients without SIRS, age ( P=0.037), ratio of total to direct bilirubin ( P=0.008), treatment method ( P=0.005) and the decline of hepatitis B virus (HBV) DNA load during therapy ( P=0.019) were independent predictors of prognosis. Treatment with lamivudine significantly decreases the mortality of fulminant hepatitis B patients without SIRS, and a rapid decline of HBV DNA load is one of the good predictors for the treatment outcome. [ABSTRACT FROM AUTHOR]

Background and Aims: Chronic hepatitis B virus (HBV) infection is a major global health issue, and the prognosis of patients with HBV-associated acute-on-chronic hepatic failure (ACLF) is extremely poor. In this study, the efficacy of lamivudine was investigated in patients with ACLF. The effects of HBV DNA load and its related factors on the prognosis were also further explored. Methods: A matched retrospective cohort study using data on ACLF patients derived from our hospital database was conducted. One hundred and thirty patients receiving lamivudine were selected into the lamivudine treatment group with another 130 without lamivudine treatment studied as control. They were matched for sex, age and imaging finding with the lamivudine treatment group. All the patients were followed up for 3 months and the survival rates were compared. The influential factors on the mortality were studied by the Cox proportional hazards model. Results: The cumulative survival rates of patients in the lamivudine group were higher than those of the control group (χ2 = 9.50, P = 0.0021). The mortality of patients in the high virus load group (71/95, 74.7%) was higher than that of those in the low virus load group (15/29, 51.7%) (χ2 = 5.536, P = 0.019). For patients with a Model for End-Stage Liver Disease (MELD) score of 20–30 by week 4, the mortality of those with HBV DNA that was undetectable or declined for more than 2 log10 (2/12, 16.7%; 18/40, 45.0%) was lower than that of those with a less than 2 log10 decline (18/23, 78.3%) (χ2 = 10.106, P = 0.001). In the Cox proportional hazards model, for patients with a MELD score of 20–30, treatment method ( P = 0.002), pretreatment HBV DNA load ( P = 0.007) and decline of HBV DNA load during therapy ( P = 0.003) were independent predictors; for those with a MELD score of above 30, MELD score ( P = 0.008) was the only independent predictor. Conclusion: Lamivudine can significantly decrease the 3-month mortality of patients with a MELD score of 20–30, and a low pretreatment viral load and rapid decline of HBV DNA load are good predictors for the outcome of the treatment. [ABSTRACT FROM AUTHOR]

Objective: To study the virological features of patients coinfected with hepatitis B virus (HBV) and hepatitis C virus (HCV) and the efficacy of combination therapy with peginterferon α-2a and ribavirin in these patients. Methods: The epidemiological and virological data of 50 patients coinfected with HBV and HCV were analysed. The virological response rates of patients treated with peginterferon α-2a and ribavirin between the HBV and HCV coinfection group and the HCV monoinfection group were compared. Results: HCV-dominant virus strains accounted for 92.0% of the 50 coinfected individuals, and HCV- and HBV-dominant virus strains accounted for the remaining 8.0%. The HBV DNA level of the patients coinfected with HBV and HCV was 4.6±0.9 log10 copies/ml, which was significantly lower than that in the HBV monoinfection group (5.9±1.2 log10 copies/ml) ( t=5.964, P<0.01). The HBeAg-positive rate (12.0%, 6/50) of the coinfection group was significantly lower than (45.3%, 19/42) that of the HBV monoinfection group (χ2=12.743, P<0.01). The partial early virological response (pEVR) rate and the end-of-treatment virological response (ETVR) rate (50.0%, 15/30; 90.0%, 27/30) of patients with genotype 1 in the coinfection group were significantly higher than those (16.0%, 4/25; 56.0%, 14/25) in the HCV monoinfection group (χ2=6.971, P=0.008; χ2=8.307, P=0.004). The relapse rate (55.6%, 15/27) of patients with genotype 1 in the coinfection group was significantly higher than that (21.4%, 3/14) in the HCV monoinfection group (χ2=4.360, P=0.037). The sustained virological response (SVR) rate (40.0%, 12/30) of patients with genotype 1 in the coinfection group was compared with that of the HCV monoinfection group (44.0%, 11/25) (χ2=0.090, P=0.765). There was no significant difference in the on-treatment virological response, ETVR, SVR and relapse rates between two groups for patients with genotype 2. The incidence of side effects (30%, 15/50) of patients in the coinfection group was significantly higher than that (13%, 6/46) in the HCV monoinfection group (χ2=4.031, P=0.045). The reactivation rate of HBV DNA (33.3%, 9/27) with HCV SVR was significantly higher than that of patients without SVR (8.7%, 2/23) (χ2=4.393, P=0.036). Conclusions: The replication of HBV was suppressed, and HCV was the dominant virus strain. Compared with HCV-monoinfected patients, pEVR, ETVR and relapse rates of patients with genotype 1 in the coinfection group were high, while they shared similar SVR rates. HBV and HCV coinfection had no impact on the rate of virological response for genotype 2. [ABSTRACT FROM AUTHOR]

Background and Aim: We used the model for end-stage liver disease (MELD) scoring system to predict the 3-month prognosis of patients with acute-on-chronic liver failure (ACLF) after plasma exchange (PE) and lamivudine treatment, and studied the predictive factors on the prognosis of patients. Methods: A total of 280 patients treated with lamivudine were randomly divided into PE and control groups. The relationship between mortality and influential factors of patients was studied by univariate and multivariate analysis. Results: The mortality (49.4%) of patients in the PE group with a MELD score from 30 to 40 was lower than that (86.1%) of the control group (χ2 = 24.546, P < 0.01). The total bilirubin (TBIL) rebound rate of the dead group was significantly higher than that of the survival group ( P < 0.01). Univariate analysis showed that mortality was significantly related to age ( P = 0.003), treatment method ( P = 0.000), TBIL ( P = 0.010), MELD score ( P = 0.001), international normalised ratio ( P = 0.014), pretreatment HBV-DNA load ( P = 0.000), decline of hepatitis B virus (HBV)–DNA load during therapy ( P = 0.013), encephalopathy ( P = 0.019), and hepatorenal syndrome ( P = 0.026). In multivariate analysis, MELD scores of 30–40, treatment method ( P = 0.003), pretreatment HBV-DNA load ( P = 0.009), decline of HBV-DNA load during therapy ( P = 0.016), and encephalopathy ( P = 0.015) were independent predictors of mortality; for MELD scores above 40, only the MELD score ( P = 0.012) was an independent predictive. Conclusions: PE significantly decreased the mortality of patients with a MELD score of 30–40. For ACLF patients with a MELD score of 30–40, a low viral load pretreatment and quick decline of HBV-DNA load are good predictors for the survival with PE and lamivudine treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: The therapeutic effect of pegylated interferon (peg-IFN)-α-2a combination with ribavirin on patients with chronic hepatitis C virus (HCV) infection is dependent on the rapidity of the virological response. The aim of this study was to investigate the predictive value of rapid virological response (RVR) and early virological response (EVR) on sustained virological response (SVR) in HCV patients treated with peg-IFN-α-2a and ribavirin. Methods: The HCV genotypes of 105 patients with chronic hepatitis C were detected by enzyme-immunoassay. Patients received subcutaneous 180 µg peg-IFN-α-2a once weekly plus daily ribavirin. Patients with genotype 1 were treated for 48 weeks and patients with genotype 2 or 3 were treated for 24 weeks. HCV RNA was assessed by qualitative PCR at pretreatment, at weeks 4 and 12 during treatment, and at week 24 of follow-up. Virological response rates at different weeks were investigated, with RVR defined as serum HCV RNA undetectable after 4 weeks and EVR defined as HCV RNA either undetectable or decrease by ≥2 log10 after 12 weeks. The effects of virological response rates at different weeks on SVR were analyzed. Results: Of the 105 patients, 44 (41.9%) were genotype 1, 46 (43.8%) were genotype 2, and 15 (14.3%) were genotype 3. RVR rates (19.5%) of patients with genotype 1 were significantly lower than those (60.7%) of genotype 2 or 3 (χ2 = 16.836, P = 0.000); and EVR rates (73.2%) of patients with genotype 1 were significantly lower than those (96.7%) of genotype 2 or 3 (χ2 = 12.220, P = 0.000). The SVR rates (86.7%) of patients who had achieved RVR were significantly higher than those (43.9%) of patients who had not achieved RVR (χ2 = 19.713, P = 0.000). The positive predictive value of RVR in all patients was higher than that of EVR, but there was no significant difference between RVR and EVR. The negative predictive value of RVR in all patients or with genotype 1 was significantly lower than that of EVR. In univariate analysis, HCV RNA level ( P = 0.014), genotype ( P = 0.001), RVR ( P = 0.000) and EVR ( P = 0.000) were associated with effect of treatment. However, in stepwise regression analysis, the independent factors associated with effect of antiviral therapy were RVR (OR = 6.501, P = 0.001), EVR (OR = 2.776, P = 0.003) and genotype (OR = 3.061, P = 0.024). Conclusions: The RVR and EVR rates of patients with genotype 1 were significantly lower than those of patients with genotype 2 or 3. RVR had a similar predictive value as EVR on SVR. Genotype, HCV RNA level, RVR and EVR were associated with SVR. Genotype, RVR and EVR were independent factors for predicting the effect of antiviral therapy. [ABSTRACT FROM AUTHOR]

Aim: To predict prognosis in patients with acute-on-chronic hepatitis (AOCH) using the model for end-stage liver disease (MELD) scoring system and to study the effects of age, sex, etiology, low serum sodium, and persistent ascites on MELD. Methods: The MELD scores of 300 patients with AOCH were calculated according to the original formula. The 3-month mortality in patients was measured, and the validity of the models was determined by means of the concordance ( c) statistic. The influential factors on MELD were also assessed. Results: The 3-month mortality of AOCH patients with a MELD score of 20–29 was 56.0%, with a score of 30–39 it was 76.5%, and with a score over 40 it was 98.2%. The concordance ( c) statistic of 3-month mortality was 0.782. Univariate analysis showed that mortality was significantly related to age ( P = 0.047), etiology ( P = 0.039), serum sodium ( P = 0.029) and ascites ( P = 0.031) for patients with MELD scores 20–29. In multivariate analysis, in patients with MELD scores 20–29, age ( P = 0.012), etiology ( P = 0.024), serum sodium ( P = 0.005) and ascites ( P = 0.017) were independent predictors of mortality; for MELD scores above 30, only MELD score ( P = 0.015) was independently predictive. Conclusions: The MELD scoring system is a reliable method for predicting mortality in patients with AOCH. In the group with MELD score 20–29, factors including age, etiology, presence of low serum sodium and persistent ascites may influence the MELD scoring system. The MELD score is the decisive predictor of the prognosis of patients with AOCH when the MELD score is over 30. [ABSTRACT FROM AUTHOR]

Objective: Hepatic steatosis is a histological feature in patients with chronic hepatitis C (CHC) and adversely affects the virologic response rates to anti-hepatitis C virus (HCV) therapy. The aim of this study is to investigate whether the fatty liver and related factors have impact on the efficacy in CHC treated with peginterferon and ribavirin, and the associations between HCV genotyping and fatty liver., Methods: Ninety-eight patients received subcutaneously 180 mug peginterferon alpha-2a once a week plus ribavirin. HCV genotypes and the levels of plasma insulin of patients were measured. Fatty liver was detected by B ultrasound. The body mass index (BMI), waist-to-hip ratio (WHR) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated., Results: Among 98 CHC patients, 38 (38.8%) were infected with genotype 1; 44 (44.9%) with genotype 2; 13 (13.3%) with genotype 3; 3 (3.0%) with indeterminate genotype. The prevalence of fatty liver was 10.5%, 11.4%, 38.5% in patients infected with HCV genotype 1, 2, 3, respectively, which suggested that the distribution of fatty liver in different HCV genotypes was imbalanced (chi2=6.758, P=0.034). In univariate analysis, the efficacy of combination therapy was significantly associated with BMI (P=0.011), WHR (P=0.024), the levels of plasma insulin (P=0.001), genotype (P=0.036), presence of fatty liver (P=0.028), treatment dosage and duration (P=0.012) and HOMA-IR (P=0.002). With binary logistic regression analysis, the plasma insulin levels and HOMA-IR showed independent predictors to the efficacy of antiviral therapy., Conclusion: The prevalence of fatty liver in HCV genotype 3 was markedly higher than that of other genotypes. The BMI, WHR, the levels of plasma insulin, genotype, presence of fatty liver, treatment dosage and duration and HOMA-IR were associated with the sustained virologic response. The level of plasma insulin and HOMA-IR were independent factors for predicting effect of antiviral therapy.