COMMENTARY

Hepatitis B

Predicting survival in hepatitis B

M Sherman

Correspondence to:
Correspondence to:
Dr M Sherman
University of Toronto and University Health Network, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada; morris.sherman@uhn.on.ca

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Alanine aminotransferase (ALT) level alone is not an appropriate indication for therapy in chronic hepatitis B infection, and other criteria in addition to ALT must be used to determine eligibility for therapy

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Keywords: HBeAg seroconversion; alanine aminotransferase; cirrhosis related complications; hepatocellular carcinoma; survival

The first 150 words of the full text of this article appear below.

Predictors of survival in chronic hepatitis B infection are surprisingly not well described. Various studies have identified different factors that were associated with adverse outcomes. For example, Niederau and colleagues,¹ in a cohort of European patients, identified lack of clearance of hepatitis B e antigen (HBeAg) as a predictor of decreased survival. Others have identified older age, presence of cirrhosis, and the persistence of alanine aminotransferase (ALT) elevations as adverse prognostic signs in an antibody to hepatitis B e antigen (anti-HBe) positive cohort.² In patients undergoing a flare of hepatitis B activity, whether spontaneous or chemotherapy induced, the presence of jaundice is an ominous sign.³ None of these adverse predictive factors are unexpected. Clearly, jaundice, cirrhosis, older age, and elevated ALT are obvious adverse predictive factors but until recently we have not had the tools to predict, years in advance, the outcome of chronic hepatitis B infection. This . . . [Full text of this article]

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