Serum HBsAg level and its clinical significance in lamivudine treatment for patients with HBeAg-negative acute-on-chronic liver failure.

Objectives: To investigate the dynamics and clinical significance of hepatitis B surface antigen (HBsAg) levels in hepatitis B e antigen (HBeAg)-negative acute-on-chronic liver failure (ACLF) patients receiving lamivudine.
Methods: Fifty-nine nucleoside-naïve patients with HBeAg-negative ACLF were enrolled and treated with 100mg of lamivudine daily. The dynamics of serum levels of HBsAg and HBV DNA were analyzed at baseline and at week 12, or before death if the patient died within 12 weeks.
Results: Twenty-eight cases died within 12 weeks and 31 cases survived after treatment. HBsAg levels of patients who survived were significantly higher than those of patients who died both pre- and post-treatment (all p<0.05). There were 33 patients with pretreatment HBsAg levels above 4000 COI and 26 cases with levels below this value. The 12-week survival rate of those with levels ≥4000 COI was significantly higher than that of patients with levels <4000 COI (66.7% (22/33) vs. 34.5% (9/26), Chi-square = 5.991, p=0.014). Regardless of the pretreatment HBsAg level, there was no significant difference in HBV DNA levels between survivors and those who died, and no correlation was observed between HBV DNA and HBsAg (all P>0.05).
Conclusions: Changes in HBsAg level could be a useful parameter for predicting the short-term outcome of lamivudine monotherapy in HBeAg-negative ACLF.
(Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)