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What MELD score mandates use of entecavir for ACLF-HBV HBeAg-negative patients?

Yan Y, Mai L, Zheng YB, Zhang SQ, Xu WX, Gao ZL, Ke WM. World J Gastroenterol. 2012 Sep 7;18(33):4604-9. doi: 10.3748/wjg.v18.i33.4604.

Source

Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.

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 log(10)/mL to 3.685 1.436 copies log(10)/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 log(10)/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 log(10)/mL; and mortality was 3.23% (1/31).

CONCLUSIONS:

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.

ACHIEVMENTS

    • Total cases enrolled = 4279
    • Total centers across Asia = 50
    • Total manuscripts = 6
    • Total video conferences conducted = 37
    • Total abstract presented in conference by AARC group = 44