Risk factors for progression to chronic hepatitis in patients with acute hepatitis B: results from the acute hepatitis B global study

MARCIANO S; FLICHMAN D; TRINKS J; MENDIZABAL M; LIVELLARA B; ARRIGO D; CALZETTA P; VUJACICH C; GIUNTA D; GADANO A

San Francisco

Congreso; The Liver Meeting 2018; 2018

American Association for the study of the Liver Diseases (AASLD)

Background. There are no recognized risk factors for progression to chronic hepatitis in adults with acute hepatitis B virus (HBV) infection. Aim. To identify risk factors of progression to chronic hepatitis in adults with acute hepatitis B. Material and methods. From August/2015 to September/2017 patients aged > 17 years with acute hepatitis B were prospectively included. Acute hepatitis B was considered in symptomatic patients with positive anti-HBc IgM and ALT > 250 IU/L. Patients were followed for 6 months and divided into two groups according to the evolution of the acute infection: Patients who resolved the infection (HBsAg clearance during follow up) and patients who evolved to chronic hepatitis (HBsAg persistence during follow up). We evaluated the effect of different factors on evolution to chronic hepatitis, including ALT < 1,700 IU/L at diagnosis. We chose this cutoff based on ROC curve analysis [negative predictive value of evolving to chronic hepatitis 97.7% (95%CI 93.3%-99.5%)]. Results. Two hundred patients were included. Median age was 44 (35-56) years and 163 (81%) were male. Sexual transmission was declared in 169 (84%) patients. HBV genotype was available in 145 patients: F: 111 (77%), A: 29 (20%)and D: 5 (3%). At diagnosis 171 (89%) were HBeAg-positive. Atotal of 23 patients (11.5%, 95% CI: 7.7%- 17.0%) evolved to chronic hepatitis. Bivariate analysis is shown in table 1. After adjusting for age, basal bilirubin and prothrombin time, for every increase in 100 IU/L in ALT at the moment of the diagnosis, the odds of evolving to chronic hepatitis was 0.85 (95%CI 0.78- 0.92, p < 0.001). Adjusting for the same variables, the odds of evolving to chronic hepatitis in patients with ALT < 1700 IU/L at diagnosis was 8.32 (95%CI 2.20 - 31.40, p 0.002). Conclusions. Patients with acute HBV infection with lower ALT levels at diagnosis are at higher risk of evolving to chronic hepatitis. Closer follow up of these patients is recommended.