Factors Differentiating Acute Hepatitis B from Acute Exacerbation of Chronic Hepatitis B in Prospective-retrospective Cohort

摘要

Introduction and Aim: It is difficult to distinguish acute hepatitis B (AVH-B) fromchronic hepatitis B with an acute exacerbation (CHB-AE) in patients whose priorhistory of HBV infection is unknown. The present study aimed to screen laboratoryparameters at presentation to discriminate between these two conditions.Materials and Methods: A prospective study was conducted in patientspresenting clinically as AVH-B without known previous chronic hepatitis B status.Patients were divided into AVH-B and CHB-AE at end of six months follow up.Clinical and laboratory profiles were compared between these two groups atpresentation.Results: There was no significant difference in clinical presentation and riskfactors profile in patients of both the groups. Mean age of presentation in AVH-Bwas 31.8 ± 14.9 years while, 47.2 ±17.3 years in CHB-AE group (p=0.005). MeanIgM anti-HBc levels were higher in AVH-B than in the CHB-AE group (p=0.001).Sensitivity, specificity, positive predictive value (PPV), and negative predictivevalue (NPV) of IgM anti-HBc [12.14 S/CO (Sample/Cut-off )] for diagnosis ofAVH-B was 76.9%, 71.4%, 76.9% and 71.4 % respectively. Quantitative HBV DNAlevels were significantly higher in CHB-AE group than in AVH-B group (p=0.015).Sensitivity, specificity, PPV and NPV of HBV DNA ( 15390 IU/ml) for diagnosisof CHB-AE was 78.6%, 46.2%, 44% and 80% respectivelyConclusions: A high percentage of patients with apparent AVH-B might be casesof CHB-AE. Elderly patient (mean 47.2 years), high titers of HBV DNA (15390 IU/mL) and low IgM anti-HBc titer (12.14 S/CO) favours CHB-AE over AVH-B.