Patients with chronic hepatitis B (CHB) may develop severe disease exacerbations with jaundice.
Some patients may progress to fulminant hepatic failure.
|Patients who died or received liver transplants:|
- lamivudine-treated = 21%
- controls = 28%
|Journal of Viral Hepatitis|
Whether early administration of lamivudine can prevent liver failure and mortality is uncertain.
In this study, a team of researchers from Hong Kong, China, investigated the role of lamivudine treatment in severe hepatitis B virus (HBV) exacerbations.
The team assessed 28 consecutive patients who presented with severe flare-up of HBV (new onset of jaundice plus alanine aminotransferase >5-times upper limit of normal) and were treated with lamivudine.
In addition, 18 historical controls who did not receive lamivudine were studied.
On admission, no patients had hepatic encephalopathy.
The researchers performed univariate analysis and multivariate logistic regression were performed on various clinical and laboratory factors for the prediction of mortality.
28 patients treated with lamivudine and 18 controls were identified.
Through out the study, 9 patients died, while 2 others received liver transplants for fulminant hepatic failure; 21% of the lamivudine-treated patients versus 28% of the controls died or received a liver transplant.
The research team found that on multivariate analysis, platelet 143 10E9/l (odds ratio, 22.4) and bilirubin >172 mol/l (odds ratio, 18.4) were independent predictors of liver-related mortality.
In addition, the mortality of patients who had thrombocytopenia and high bilirubin, thrombocytopenia, high bilirubin, and no risk factor were 69%, 11%, 13% and 0% respectively.
Dr Chan's team concluded, "Hence lamivudine confers no survival benefit to conventional treatment in severe exacerbations of CHB".
"Patients with thrombocytopenia and high bilirubin should be considered for liver transplantation".