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Publication Information
Affiliation
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA.
Authors
Acute Liver Failure Study Group, Attar N, Balko J, Blei A, Brown R, Chung RT, Crippin J, Dao DY, Davern T, Fontana R, Han SH, Harrison E, Hassanein T, Hay J, Hynan LS, Lalani E, Larson AM, Lee WM, Lok AS, McCashland T, McGuire B, Munoz S, Murray M, Murray N, Ostapowicz GA, Pezzia C, Polson J, Reddy R, Reisch JS, Reuben A, Rossaro L, Samuel G, Sanders C, Satyanarayana R, Schilsky M, Schiødt FV, Shaikh A, Smith A, Smith JP, Stravitz R, Webster JW, Word RA, Yuan HJ, Zaman A
Studies
Citation
Dao DY, Hynan LS, Yuan HJ, Sanders C, Balko J, Attar N, Lok AS, Word RA, Lee WM, Acute Liver Failure Study Group. Two distinct subtypes of hepatitis B virus-related acute liver failure are separable by quantitative serum immunoglobulin M anti-hepatitis B core antibody and hepatitis B virus DNA levels. Hepatology 2012 Mar;55(3):676-84. Epub 2012 Jan 31.Abstract
Hepatitis B virus (HBV)-related acute liver failure (HBV-ALF) may occur after acute HBV infection (AHBV-ALF) or during an exacerbation of chronic HBV infection (CHBV-ALF). Clinical differentiation of the two is often difficult if a previous history of HBV is not available. Quantitative measurements of immunoglobulin M (IgM) anti-hepatitis B core antibody (anti-HBc) titers and of HBV viral loads (VLs) might allow the separation of AHBV-ALF from CHBV-ALF. Of 1,602 patients with ALF, 60 met clinical criteria for AHBV-ALF and 27 for CHBV-ALF. Sera were available on 47 and 23 patients, respectively. A quantitative immunoassay was used to determine IgM anti-HBc levels, and real-time polymerase chain reaction (rtPCR) was used to determine HBV VLs. AHBV-ALFs had much higher IgM anti-HBc titers than CHBV-ALFs (signal-to-noise [S/N] ratio median: 88.5; range, 0-1,120 versus 1.3, 0-750; P < 0.001); a cut point for a S/N ratio of 5.0 correctly identified 44 of 46 (96%) AHBV-ALFs and 16 of 23 (70%) CHBV-ALFs; the area under the receiver operator characteristic curve was 0.86 (P < 0.001). AHBV-ALF median admission VL was 3.9 (0-8.1) log10 IU/mL versus 5.2 (2.0-8.7) log10 IU/mL for CHBV-ALF (P < 0.025). Twenty percent (12 of 60) of the AHBV-ALF group had no hepatitis B surface antigen (HBsAg) detectable on admission to study, wheras no CHBV-ALF patients experienced HBsAg clearance. Rates of transplant-free survival were 33% (20 of 60) for AHBV-ALF versus 11% (3 of 27) for CHBV-ALF (P = 0.030).