PROGNOSIS AND ITS RELATED FACTORS IN PATIENTS WITH HEPATITIS B VIRUS-RELATED LIVER CIRRHOSIS IN THE ANTIVIRAL ERA

Abstract

Background and Aims: Oral anti-viral agents are known to improve clinical outcome of chronic hepatitis B patients by inhibiting viral replication and it is believed that these drugs might have considerably altered the prognosis of patients with hepatitis B virus (HBV)-related cirrhosis. This retrospective cohort study was conducted to evaluate the degree of improvement in prognosis and its related factors in these patients during the era of oral anti-viral therapy.

Methods: A total of 240 patients with HBV-related cirrhosis with no previous history of anti-viral therapy who were initially treated with lamivudine were enrolled in this study. Mortality, progression to decompensated cirrhosis, development of hepatocellular carcinoma (HCC), and factors related to the aforementioned parameters were assessed.

Results: Mean age of the patients was 49.6 years and 67.5% were male. The proportion of patients with CP grade A, B, and C was 59.6%, 27.1%, and 13.3%, respectively. Forty-one patients died during the mean duration of follow-up of 46 months and the 5-year survival rate was 80.6%. The 5-year incidences of progression to decompensated cirrhosis and HCC was 15.4% and 13.8%, respectively. The 5-year survival rate according to CP grade at baseline was 90.9%, 62.8%, and 62.2% for grade A, B, and C, respectively. The cumulative survival rate was significantly higher in patients with CP grade A compared to those with CP grade B and C (P = 0.0001), but it did not differ between CP grade B and C (P = 0.6560). Among the variables at baseline, platelet count (P = 0.005), serum bilirubin level (P = 0.022), CP score (P = 0.003) were independent prognostic factors for mortality in multivariate analysis, while only age was significantly related with the development of HCC (P = 0.036).

Conclusion: With the introduction of oral anti-viral agents, progression to decompensation in hepatitis B related cirrhosis patients has reduced, and the prognosis in decompensated patients and overall survival rate have improved. This seems to have affected the power of CP score to predict the prognosis in hepatitis B related cirrhosis patients during follow-up, such as mortality. Therefore, development of an improved scoring system that can better predict the prognosis would be necessary.