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Clinical outcomes of lamivudine-adefovir therapy in chronic hepatitis B cirrhosis.

Authors :
Lim SG
Aung MO
Mak B
Sutedja D
Lee YM
Lee GH
Fernandes M
Low HC
Lai V
Dan YY
Source :
Journal of clinical gastroenterology [J Clin Gastroenterol] 2011 Oct; Vol. 45 (9), pp. 818-23.
Publication Year :
2011

Abstract

Goals: To determine the clinical outcome of chronic hepatitis B cirrhotics on antiviral therapy.<br />Background: The long-term outcome of hepatitis B cirrhotics on therapy remains to be characterized.<br />Methods: A large clinic cohort of chronic hepatitis B cirrhotic patients were enrolled in a treatment program of lamivudine ± adefovir therapy. Patients were analyzed for clinical outcomes, and predictors of these outcomes were evaluated by multivariate analysis. Clinical outcomes of ascites, encephalopathy, hepatocellular carcinoma (HCC), and progression in Child-Pugh score, Model for End-stage Liver Disease score, and mortality were assessed. Data were analyzed by Kaplan-Meier graphs, log-rank test, and Cox regression.<br />Results: Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated cirrhosis. At 5 years, the mean survival was 83.6%, development of ascites, HCC, encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%, and 16.9%, respectively. The overall progression of liver-related complications was 32.8% at 5 years. Multivariate analysis showed that ascites, albumin ≤28 g/L, Child-Pugh score ≥7.9, Model for End-stage Liver Disease score ≥10.9 were significantly associated with liver-related complications. Low albumin and low hepatitis B virus DNA were independent factors for liver-associated mortality. Lamivudine resistance did not affect mortality or liver disease progression. When stratified by Child-Pugh status, the mean survival of those with Child C cirrhosis was worse than Child A and B cirrhosis (P<0.001, log-rank test). Early deaths (≤12 mo) were due to liver failure or sepsis, whereas deaths ≥12 mo were mainly due to HCC.<br />Conclusion: Decompensated chronic hepatitis B cirrhotics may suffer early mortality despite antiviral treatment, and therefore should be considered for early liver transplantation.

Details

Language :
English
ISSN :
1539-2031
Volume :
45
Issue :
9
Database :
MEDLINE
Journal :
Journal of clinical gastroenterology
Publication Type :
Academic Journal
Accession number :
21921845
Full Text :
https://doi.org/10.1097/MCG.0b013e318214ab5d