| 抄録 |
Background and Aims ： Severe acute exacerbation is a potentially fatal complication of chronic hepatitis Bbut predictors for mortality remain incompletely understood in the era of antiviral therapy． The role ofpretreatment vi／ral load in predicting outcomes has not been elucidated．Methods ： This retrospective cohort study enrolled consecutive treatment－naive patients receiving nu－cleos（t）ide analogues for severe acute exacerbation of chronic hepatitis Bdefined as abruptly elevated se－rum alanine aminotransferase＞10 times the upper limit of normal along with hyperbilirubinemia． Sur－vival pattern was evaluated by the Kaplan－Meier method and pretreatment predictors for mortality de－termined using Cox regression analysis．Results ： Sixty six patients were eligible and followed． up for a median of 23 months （rangeO．1－75） ． Twenty（30．3 O／o ） of them died during the study periodmostly （n ＝ 18） succumbing within 6 months． All deaths oc－curred in the 35 （53 0／o ） patients who developed acute on chronic liver failure within 2 weeks． Pretreatmentpre dictors independently associated with mortality were age （hazard ratio ［HR］1．10 per year ； 950／o con－fidence interval ［CI］1．05－1．15） international normalized ratio （INR） of prothrombin time （HR2．68 perunit ； 950／o CI1．81－398）viral load （HR1．49 per log copies／mL ； 950／o CI1．13－1．96）and platelet count （HRO．87 per 104／ptL ； 950／o CIO．78－O．98）． Stratified analyses revealed baseline viral DNA predicted mortalitymainly in patients without pronounced coagulopathybut insignificantly in those presenting with a mark－edly prolonged prothrombin time （INR＞1．7）．Concl！usions ： Pretreatment viral load apart from ageINRand platelet count predicts mortality for se－vere acute exacerbation of chronic hepatitis B treated with antiviral therapy |
