Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2012; 18(33): 4604-4609
Published online Sep 7, 2012. doi: 10.3748/wjg.v18.i33.4604
What MELD score mandates use of entecavir for ACLF-HBV HBeAg-negative patients?
Ying Yan, Li Mai, Yu-Bao Zheng, Shao-Quan Zhang, Wen-Xiong Xu, Zhi-Liang Gao, Wei-Min Ke
Ying Yan, Li Mai, Yu-Bao Zheng, Shao-Quan Zhang, Wen-Xiong Xu, Zhi-Liang Gao, Wei-Min Ke, Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Yan Y and Mai L contributed equally to this work; Yan Y, Mai L and Ke WM designed the research; Yan Y, Mai L, Zheng YB, Zhang SQ, Xu WX and Gao ZL performed the research; Yan Y, Mai L, Zheng YB, Zhang SQ and Xu WX collected data; Yan Y and Mai L analyzed the data; Yan Y, Mai L and Ke WM wrote the paper.
Supported by Grants from the Technology Project Fund of Guangdong Province, China, No. 2010B080701024; The Natural Science Fund of Guangdong Province, No. 10451008901004818; The National Natural Science Foundation of China, No. 30971356; The National Grand Program on Key Infectious Disease in the Treatment and Prevention of Infectious Diseases of AIDS and Viral Hepatitis, China, No. 2012ZX10002007-002; The Medical science and Technology Research Fund of Guangdong Province, China, No. B2011101
Correspondence to: Wei-Min Ke, Professor, Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China. kwm1999@163.com
Telephone: +86-20-85253172 Fax: +86-20-85253172
Received: October 13, 2011
Revised: April 13, 2012
Accepted: April 20, 2012
Published online: September 7, 2012
Abstract

AIM: To investigate optimal timing for therapeutic efficacy of entecavir for acute-on-chronic hepatitis B liver failure (ACLF-HBV) in hepatitis B e antigen (HBeAg)-negative patients.

METHODS: A total of 109 inpatients with ACLF-HBV were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University from October 2007 to October 2010. Entecavir 0.5 mg/d was added to each patient’s comprehensive therapeutic regimen. Patients were divided into three groups according to model for end-stage liver disease (MELD) score: high (≥ 30, 20 males and 4 females, mean age 47.8 ± 13.5 years); intermediate (22-30, 49 males and 5 females, 45.9 ± 12.4 years); and low (≤ 22, 28 males and 3 females, 43.4 ± 9.4 years). Statistical analysis were performed using SPSS 11.0 software. Data with normal distribution were expressed as mean ± SD and comparisons were made with Student’s t tests. A value of P < 0.05 was considered statistically significant. Viral loads were related exponentially and logarithmic data were used for analysis.

RESULTS: For 24 patients with MELD score ≥ 30, treatment lasted 17.2 ± 16.5 d. Scores before and after treatment were significantly different (35.97 ± 4.87 and 40.48 ± 8.17, respectively, t = -2.762, P = 0.011); HBV DNA load was reduced (4.882 ± 1.847 copies log10/mL to 3.685 ± 1.436 copies log10/mL); and mortality rate was 95.83% (23/24). Of 54 patients with scores of 22-30, treatment lasted for 54.0 ± 43.2 d; scores before and after treatment were 25.87 ± 2.33 and 25.82 ± 13.92, respectively (t = -0.030, P = 0.976); HBV DNA load decreased from 6.308 ± 1.607 to 3.473 ± 2.097 copies log10/mL; and mortality was 51.85% (28/54). Of 31 patients with scores ≤ 22, treatment lasted for 66.1 ± 41.9 d; scores before and after treatment were 18.88 ± 2.44 and 12.39 ± 7.80, respectively, (t = 4.860, P = 0.000); HBV DNA load decreased from 5.841 ± 1.734 to 2.657 ± 1.154 copies log10/mL; and mortality was 3.23% (1/31).

CONCLUSION: For HBeAg-negative patients with ACLF-HBV, when entecavir was added to comprehensive therapy, a MELD score ≥ 30 predicted very poor prognosis due to fatal liver failure.

Keywords: Acute-on-chronic hepatitis B liver failure; Hepatitis B e antigen negativity; Entecavir; Model for end-stage liver disease; Mortality