Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase
Background/Aims The histologic status of the immune-tolerant (IT) phase of chronic hepatitis B relative to long-term outcomes is unclear. This study aimed to discover how the serological criteria currently in use correspond to histologic criteria in determining the IT phase and indication for liver...
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| Format: | Article |
| Language: | English |
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Korean Association for the Study of the Liver
2023-04-01
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| Series: | Clinical and Molecular Hepatology |
| Subjects: | |
| Online Access: | http://e-cmh.org/upload/pdf/cmh-2022-0322.pdf |
| _version_ | 1797844846731329536 |
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| author | Jeong-Ju Yoo Soo Young Park Ji Eun Moon Yu Rim Lee Han Ah Lee Jieun Lee Young Seok Kim Yeon Seok Seo Sang Gyune Kim |
| author_facet | Jeong-Ju Yoo Soo Young Park Ji Eun Moon Yu Rim Lee Han Ah Lee Jieun Lee Young Seok Kim Yeon Seok Seo Sang Gyune Kim |
| author_sort | Jeong-Ju Yoo |
| collection | DOAJ |
| description | Background/Aims The histologic status of the immune-tolerant (IT) phase of chronic hepatitis B relative to long-term outcomes is unclear. This study aimed to discover how the serological criteria currently in use correspond to histologic criteria in determining the IT phase and indication for liver biopsy. Methods Patients in the serological IT phase determined by positive hepatitis B e antigen, hepatitis B virus (HBV) DNA ≥106 IU/mL, and normal or minimally elevated alanine aminotransferase (ALT) ≤60 IU/L, who underwent liver biopsy at three different hospitals were included. The distribution of the histologic IT phase, defined as fibrosis of stage 1 or less and inflammation of grade 1 or less, was compared with that of the serological IT phase. The risk factors for the incidence of liver-related events, such as hepatocellular carcinoma, liver cirrhosis, liver transplantation, and death, were also analyzed. Results Eighty-two (31.7%) out of 259 clinically suspected IT phase patients belonged to the histologic IT phase. Age over 35, high AST, and low albumin were useful for ruling out the histologic IT phase. Risk factors predicting liver-related events were age and significant fibrosis stage. There was no significant difference in the proportion of histologic IT phase and clinical prognosis between normal ALT and mildly elevated ALT groups. However, even in patients with normal ALT, age was an important factor in predicting the presence of the histologic IT phase. Conclusions A significant number of patients who belonged to the serological IT phase were not in the histologic IT phase. Patients over 35 years and those with high AST, low albumin, and low HBV DNA levels were more likely to experience poor long-term clinical outcomes. Therefore, additional histologic assessment should be considered. |
| first_indexed | 2024-04-09T17:30:03Z |
| format | Article |
| id | doaj.art-27fc79c5a8ea4b81be84b30f305bd81b |
| institution | Directory Open Access Journal |
| issn | 2287-2728 2287-285X |
| language | English |
| last_indexed | 2024-04-09T17:30:03Z |
| publishDate | 2023-04-01 |
| publisher | Korean Association for the Study of the Liver |
| record_format | Article |
| series | Clinical and Molecular Hepatology |
| spelling | doaj.art-27fc79c5a8ea4b81be84b30f305bd81b2023-04-18T07:21:34ZengKorean Association for the Study of the LiverClinical and Molecular Hepatology2287-27282287-285X2023-04-0129248249510.3350/cmh.2022.03221763Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phaseJeong-Ju Yoo0Soo Young Park1Ji Eun Moon2Yu Rim Lee3Han Ah Lee4Jieun Lee5Young Seok Kim6Yeon Seok Seo7Sang Gyune Kim8 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea College of Medicine, Soonchunhyang University, Cheonan, Korea Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, KoreaBackground/Aims The histologic status of the immune-tolerant (IT) phase of chronic hepatitis B relative to long-term outcomes is unclear. This study aimed to discover how the serological criteria currently in use correspond to histologic criteria in determining the IT phase and indication for liver biopsy. Methods Patients in the serological IT phase determined by positive hepatitis B e antigen, hepatitis B virus (HBV) DNA ≥106 IU/mL, and normal or minimally elevated alanine aminotransferase (ALT) ≤60 IU/L, who underwent liver biopsy at three different hospitals were included. The distribution of the histologic IT phase, defined as fibrosis of stage 1 or less and inflammation of grade 1 or less, was compared with that of the serological IT phase. The risk factors for the incidence of liver-related events, such as hepatocellular carcinoma, liver cirrhosis, liver transplantation, and death, were also analyzed. Results Eighty-two (31.7%) out of 259 clinically suspected IT phase patients belonged to the histologic IT phase. Age over 35, high AST, and low albumin were useful for ruling out the histologic IT phase. Risk factors predicting liver-related events were age and significant fibrosis stage. There was no significant difference in the proportion of histologic IT phase and clinical prognosis between normal ALT and mildly elevated ALT groups. However, even in patients with normal ALT, age was an important factor in predicting the presence of the histologic IT phase. Conclusions A significant number of patients who belonged to the serological IT phase were not in the histologic IT phase. Patients over 35 years and those with high AST, low albumin, and low HBV DNA levels were more likely to experience poor long-term clinical outcomes. Therefore, additional histologic assessment should be considered.http://e-cmh.org/upload/pdf/cmh-2022-0322.pdffibrosisbiopsyhepatitis b virus |
| spellingShingle | Jeong-Ju Yoo Soo Young Park Ji Eun Moon Yu Rim Lee Han Ah Lee Jieun Lee Young Seok Kim Yeon Seok Seo Sang Gyune Kim Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase Clinical and Molecular Hepatology fibrosis biopsy hepatitis b virus |
| title | Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase |
| title_full | Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase |
| title_fullStr | Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase |
| title_full_unstemmed | Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase |
| title_short | Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase |
| title_sort | long term prognosis and the need for histologic assessment of chronic hepatitis b in the serological immune tolerant phase |
| topic | fibrosis biopsy hepatitis b virus |
| url | http://e-cmh.org/upload/pdf/cmh-2022-0322.pdf |
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