Impact of comorbidities on the severity of chronic hepatitis B at presentation

• Published in: World journal of gastroenterology : WJG Vol. 18; no. 14; pp. 1616 - 1621
• Main Author: Sagnelli, Evangelista
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 14.04.2012
• Subjects: Adult; Age Factors; Aged; Alcoholism - epidemiology; Brief; Comorbidity; Female; Hepatitis B, Chronic - epidemiology; Hepatitis C - epidemiology; Hepatitis D - epidemiology; HIV Infections - epidemiology; Humans; Italy - epidemiology; Liver Cirrhosis - epidemiology; Male; Middle Aged; Severity of Illness Index; 丙型肝炎病毒; 临床意义; 乙型肝炎病毒; 乙肝表面抗原; 合并症; 多元统计分析; 慢性乙型肝炎; 病毒感染; Italy; Hepatitis B virus/hepatitis D virus dual infection; Alcohol abuse; Chronic hepatitis B; Hepatitis B virus/hepatitis C virus dual infection
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v18.i14.1616

AIM：To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS：Out of 1366 hepatitis B surface antigen（HBsAg） positive subjects consecutively observed in 79 Italian hospitals,53（4.3%） showed as the only cofactor hepatitis D virus（HDV） infection [hepatitis B virus（HBV）/HDV group],130（9.5%） hepatitis C virus（HCV）（group HBV/HCV）,6（0.4%） human immunodeficiencyvirus（HIV）（group HBV/HIV）,138（10.2%） alcohol abuse（group HBV/alcohol）;109（8.0%） subjects had at least two cofactors and 924 were in the cofactor-free（CF） group.RESULTS：Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis（P 0.001）,those in group HBV/HDV were younger（P 0.001）,more frequently resided in the south of the country and had cirrhosis（P 0.001）,those in group HBV/HCV were older（P 0.001） and more frequently had cirrhosis（P 0.001）.These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients.Multivariate analysis showed that an older age [odds ratio（OR） 1.06,95% CI：1.05-1.08],alcohol abuse with more than 8 drinks daily（OR 2.89,95% CI：1.81-4.62） and anti-HDV positivity（OR 3.48,95% CI：2.16-5.58） are all independently associated with liver cirrhosis.This association was found also for anti-HCV positivity in univariate analysis,but it was no longer associated（OR 1.23,95% CI：0.84-1.80） at multivariate analysis.CONCLUSION：Older age,HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection,while HCV replication plays a lesser role in the severity of hepatic damage.