The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer?
Background/Aims Acute exacerbations of chronic hepatitis B (CHB-AEs) are common in endemic areas and are often presumed to be acute hepatitis B (AHB) due to their similarities in clinical and serological pictures, presenting a major diagnostic dilemma. This study aimed to identify laboratory markers...
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| Format: | Article |
| Language: | English |
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Korean Association for the Study of the Liver
2020-04-01
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| Series: | Clinical and Molecular Hepatology |
| Subjects: | |
| Online Access: | http://e-cmh.org/upload/pdf/cmh-2019-0060.pdf |
| _version_ | 1819169514313482240 |
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| author | Sujata Lall Pragya Agarwala Guresh Kumar Manoj Kumar Sharma Ekta Gupta |
| author_facet | Sujata Lall Pragya Agarwala Guresh Kumar Manoj Kumar Sharma Ekta Gupta |
| author_sort | Sujata Lall |
| collection | DOAJ |
| description | Background/Aims Acute exacerbations of chronic hepatitis B (CHB-AEs) are common in endemic areas and are often presumed to be acute hepatitis B (AHB) due to their similarities in clinical and serological pictures, presenting a major diagnostic dilemma. This study aimed to identify laboratory markers for differentiating between the two groups, and to establish the cut-off value for significant markers. Methods A retrospective analysis of records was conducted for patients who presented with clinical features of acute hepatitis along with hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity from May 2015 to May 2017. A total of 172 patients were enrolled and grouped as AHB (n=89) and CHB-AE (n=83) based on their history of hepatitis B virus infection and duration of HBsAg persistence. Virological and biochemical parameters were analyzed and compared. Cut-off values, sensitivity, and specificity of the variables were calculated. Results The median value of signal by cut-off (S/Co) ratio for IgM anti-HBc was significantly higher in AHB group (30.44) compared to CHB-AE group (8.63) with a sensitivity and specificity of 97% and 84%, respectively, at a cut-off of 20.5 (P<0.01). The mean international normalized ratio (INR) was significantly greater in CHB-AE (1.88±1.24) group compared to AHB group (1.62±0.17) with a sensitivity and specificity of 57.9% and 45.1%, respectively, at a cut-off value of 1.27. Conclusions A value of 20.5 S/Co of IgM anti-HBc and 1.27 INR could be helpful in differentiating between AHB and CHB-AE. (Clin Mol Hepatol 2020;26:187-195) |
| first_indexed | 2024-12-22T19:20:42Z |
| format | Article |
| id | doaj.art-947f9d334ffd46c697ac152747937e90 |
| institution | Directory Open Access Journal |
| issn | 2287-2728 2287-285X |
| language | English |
| last_indexed | 2024-12-22T19:20:42Z |
| publishDate | 2020-04-01 |
| publisher | Korean Association for the Study of the Liver |
| record_format | Article |
| series | Clinical and Molecular Hepatology |
| spelling | doaj.art-947f9d334ffd46c697ac152747937e902022-12-21T18:15:23ZengKorean Association for the Study of the LiverClinical and Molecular Hepatology2287-27282287-285X2020-04-0126218719510.3350/cmh.2019.00601503The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer?Sujata Lall0Pragya Agarwala1Guresh Kumar2Manoj Kumar Sharma3Ekta Gupta4 Department of Clinical Virology, Institute of liver and Biliary Sciences, Delhi 110070, India Department of Clinical Virology, Institute of liver and Biliary Sciences, Delhi 110070, India Department of Clinical Research, Institute of liver and Biliary Sciences, Delhi 110070, India Department of Hepatology, Institute of liver and Biliary Sciences, Delhi 110070, India Department of Clinical Virology, Institute of liver and Biliary Sciences, Delhi 110070, IndiaBackground/Aims Acute exacerbations of chronic hepatitis B (CHB-AEs) are common in endemic areas and are often presumed to be acute hepatitis B (AHB) due to their similarities in clinical and serological pictures, presenting a major diagnostic dilemma. This study aimed to identify laboratory markers for differentiating between the two groups, and to establish the cut-off value for significant markers. Methods A retrospective analysis of records was conducted for patients who presented with clinical features of acute hepatitis along with hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity from May 2015 to May 2017. A total of 172 patients were enrolled and grouped as AHB (n=89) and CHB-AE (n=83) based on their history of hepatitis B virus infection and duration of HBsAg persistence. Virological and biochemical parameters were analyzed and compared. Cut-off values, sensitivity, and specificity of the variables were calculated. Results The median value of signal by cut-off (S/Co) ratio for IgM anti-HBc was significantly higher in AHB group (30.44) compared to CHB-AE group (8.63) with a sensitivity and specificity of 97% and 84%, respectively, at a cut-off of 20.5 (P<0.01). The mean international normalized ratio (INR) was significantly greater in CHB-AE (1.88±1.24) group compared to AHB group (1.62±0.17) with a sensitivity and specificity of 57.9% and 45.1%, respectively, at a cut-off value of 1.27. Conclusions A value of 20.5 S/Co of IgM anti-HBc and 1.27 INR could be helpful in differentiating between AHB and CHB-AE. (Clin Mol Hepatol 2020;26:187-195)http://e-cmh.org/upload/pdf/cmh-2019-0060.pdfhepatitis b virusacute hepatitischronic hepatitisdistinction |
| spellingShingle | Sujata Lall Pragya Agarwala Guresh Kumar Manoj Kumar Sharma Ekta Gupta The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer? Clinical and Molecular Hepatology hepatitis b virus acute hepatitis chronic hepatitis distinction |
| title | The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer? |
| title_full | The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer? |
| title_fullStr | The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer? |
| title_full_unstemmed | The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer? |
| title_short | The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer? |
| title_sort | dilemma of differentiating between acute hepatitis b and chronic hepatitis b with acute exacerbation is quantitative serology the answer |
| topic | hepatitis b virus acute hepatitis chronic hepatitis distinction |
| url | http://e-cmh.org/upload/pdf/cmh-2019-0060.pdf |
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