Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy

Robert J. Fontana, Hie Won L Hann, Robert P. Perrillo, John M. Vierling, Theresa Wright, Jorge Rakela, Gaya Anschuetz, Randy Davis, Stephen D. Gardner, Nathaniel A. Brown

Research output: Contribution to journalArticle

222 Citations (Scopus)

Abstract

Background & Aims: Chronic hepatitis B is a leading cause of death worldwide. To identify patients who might require urgent liver transplantation despite antiviral therapy, we investigated the determinants of early mortality in a large cohort of patients with decompensated chronic hepatitis B treated with lamivudine. Methods: One hundred fifty-four North American patients with decompensated chronic hepatitis B received lamivudine for a median of 16 months. Univariate and multivariate Cox regression modeling was used to develop a model of 6-month mortality. Results: A biphasic survival pattern was observed, with most deaths occurring within the first 6 months of treatment (25 of 32, 78%) because of complications of liver failure. The estimated actuarial 3-year survival of patients who survived at least 6 months was 88% on continued treatment. In multivariate modeling, elevated pretreatment serum bilirubin and creatinine levels as well as the presence of detectable hepatitis B virus (HBV) DNA (by the bDNA assay) pretreatment were significantly associated with 6-month mortality. An equation approximating the probability of early mortality was developed from these variables. Conclusions: Our data demonstrate a distinct alteration in the slope of the survival curve after 6 months of lamivudine treatment for decompensated chronic hepatitis B. An equation consisting of 3 widely available pretreatment laboratory parameters was developed that can be used to predict the likelihood of early death in patients receiving lamivudine for decompensated chronic hepatitis B. These observations may help identify patients who can be stabilized with suppressive antiviral therapy vs. those who require urgent liver transplantation.

Original languageEnglish (US)
Pages (from-to)719-727
Number of pages9
JournalGastroenterology
Volume123
Issue number3
DOIs
StatePublished - Sep 2002
Externally publishedYes

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Chronic Hepatitis B
Antiviral Agents
Lamivudine
Mortality
Liver Transplantation
Survival
Therapeutics
Branched DNA Signal Amplification Assay
Liver Failure
Bilirubin
Hepatitis B virus
Cause of Death
Creatinine
DNA
Serum

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Fontana, R. J., Hann, H. W. L., Perrillo, R. P., Vierling, J. M., Wright, T., Rakela, J., ... Brown, N. A. (2002). Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy. Gastroenterology, 123(3), 719-727. https://doi.org/10.1053/gast.2002.35352

Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy. / Fontana, Robert J.; Hann, Hie Won L; Perrillo, Robert P.; Vierling, John M.; Wright, Theresa; Rakela, Jorge; Anschuetz, Gaya; Davis, Randy; Gardner, Stephen D.; Brown, Nathaniel A.

In: Gastroenterology, Vol. 123, No. 3, 09.2002, p. 719-727.

Research output: Contribution to journalArticle

Fontana, RJ, Hann, HWL, Perrillo, RP, Vierling, JM, Wright, T, Rakela, J, Anschuetz, G, Davis, R, Gardner, SD & Brown, NA 2002, 'Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy', Gastroenterology, vol. 123, no. 3, pp. 719-727. https://doi.org/10.1053/gast.2002.35352
Fontana, Robert J. ; Hann, Hie Won L ; Perrillo, Robert P. ; Vierling, John M. ; Wright, Theresa ; Rakela, Jorge ; Anschuetz, Gaya ; Davis, Randy ; Gardner, Stephen D. ; Brown, Nathaniel A. / Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy. In: Gastroenterology. 2002 ; Vol. 123, No. 3. pp. 719-727.
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