Two distinct subtypes of hepatitis B virus-related acute liver failure are separable by quantitative serum IgM anti-HBc and HBV DNA levels

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http://onlinelibrary.wiley.com/doi/10.1002/hep.24732/abstract;jsessionid=63BB4B5\

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Two distinct subtypes of hepatitis B virus-related acute liver failure are

separable by quantitative serum IgM anti-HBc and HBV DNA levels

Doan Y Dao1, S. Hynan2, He-Jun Yuan1, Corron 1, Jody Balko1, Nahid

Attar1, S.F. Lok3, R. Ann Word4, M. Lee1,*,†,

The Acute Liver Failure Study Group1DOI: 10.1002/hep.24732

Copyright © 2011 American Association for the Study of Liver Diseases

Issue

Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background:

Hepatitis B virus-related acute liver failure (HBV-ALF) may occur following

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 prior history of hepatitis B is not available. Quantitative measurements of

anti-hepatitis B core immunoglobulin M (IgM anti-HBc) titers and of HBV viral

loads (VLs) might allow separation of acute from chronic HBV-ALF.

Methods:

Of 1602 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) to determine HBV VLs.

Results:

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, vs. 1.3, 0-750, p<0.001); a cut point

for S/N ratio of 5.0 correctly identified 44/46 (96%) AHBV-ALFs and 16/23 (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, vs. 5.2

(2.0-8.7) log10 IU/mL for CHBV-ALF, p<0.025. Twenty percent (12/60) of the

AHBV-ALF group had no hepatitis B surface antigen (HBsAg) detectable on

admission to study, while no CHBV-ALF patients experienced HBsAg clearance.

Rates of transplant-free survival were 33% (20/60) for AHBV-ALF vs. 11% (3/27)

for CHBV-ALF, p=0.030.

Conclusions:

AHBV-ALF and CHBV-ALF differ markedly in IgM anti-HBc titers, in HBV VLs and in

prognosis, suggesting that the two forms are indeed different entities that

might each have a unique pathogenesis. (HEPATOLOGY 2011.)