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Clinical outcomes of lamivudine-adefovir therapy in chronic hepatitis B cirrhosis.
- 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.
- Subjects :
- Adenine analogs & derivatives
Adenine therapeutic use
Aged
Cohort Studies
Disease Progression
Drug Therapy, Combination
Female
Follow-Up Studies
Hepatitis B, Chronic physiopathology
Humans
Kaplan-Meier Estimate
Lamivudine therapeutic use
Liver Cirrhosis physiopathology
Liver Cirrhosis virology
Male
Middle Aged
Multivariate Analysis
Organophosphonates therapeutic use
Proportional Hazards Models
Prospective Studies
Risk Factors
Severity of Illness Index
Survival Rate
Treatment Outcome
Antiviral Agents therapeutic use
Hepatitis B, Chronic drug therapy
Liver Cirrhosis drug therapy
Subjects
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