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N o v e m b e r 1 2 - 1 3 , 2 0 1 8 | R o m e , I t a l y
Joint Event on
OF EXCELLENCE
IN INTERNATIONAL
MEETINGS
YEARS
Surgery and Anesthesia 2018 & Euro Gastro Congress 2018 Case Reports in Surgery and Invasive Procedures| Volume 2
&
GASTROENTEROLOGY
3rd International Conference on
SURGERY AND ANESTHESIA
International Conference on
Da-Wu Zeng, Case Rep Surg Invasive Proced 2018, Volume 2
VALUE OF HEPATITIS B SURFACE ANTIGEN
IN THE PREDICTION OF LIVER INJURY
AMONG PATIENTS WITH IMMUNE-
TOLERATE PHASE CHRONIC HEPATITIS B
Da-Wu Zeng
Fujian Medical University, China
Background/Aims: It has been demonstrated that significant fibrosis occurs
in a proportion of hepatitis B e-antigen (HBeAg) positive patients (22.5–
49.4%) with persistently normal serum alanine transaminase (ALT) levels.
Notably, chronic hepatitis B (CHB) in the immune-tolerate (IT) phase, if left
untreated, is significantly associated with high risks of hepatocellular carci-
noma (HCC) and death. HBeAg-positive chronic hepatitis B virus (HBV) infec-
tion still has the risk of developing HCC, suggesting a need for the treatment
of IT-phase CHB patients, particularly for those individuals with the presence
of liver injury for slowdown the disease progression. This multiCentre study
aimed to develop a noninvasive model to predict significant fibrosis among
CHB patients in the IT phase.
Materials and methods: A total of 113 CHB patients who were classified as IT-
phase CHB with HBeAg positive, high HBV DNA (more than 107 IU/mL), and
normal ALT at the time of liver biopsy, were retrospectively recruited in this
multicentre study. Relationships between HBsAg and liver fibrosis were an-
alysed by Spearman rank correlation. Receiver operator characteristic (ROC)
curves were used to evaluate the diagnostic value of HBsAg for the predic-
tion of liver fibrosis. Multivariate logistic regression analysis was conducted
to construct a non-invasive model for the prediction of significant fibrosis
among the IT-phase CHB patients. Results: DS-defined IT-phase CHB patients
(HBeAg positive, HBV DNA ≥ 1,000,000 IU/mL, and normal ALT) and histo-
logical profiles (necroinflammatory score <4 and fibrosis≤1 on liver biopsy)
had significantly higher HBsAg levels than the non-IT patients. The quanti-
tative HBsAg level can help identify IT patients with potential liver injury. The
optimal level of HBsAg to identify DS IT was log 4.46 IU/mL with an AUC of
0.77, a sensitivity of 72.7%, a specificity of 79.7%, a PPV of 69.6% and a NPV
of 82.1%, while log 4.44 IU/ml for F≥2 gave an AUC of 0.83, a sensitivity of
81.1%, a specificity of 81.6%, a PPV of 68.2% and a NPV of 89.9%, respectively
Conclusions: Approximately one-third of the IT-phase CHB patients may have
medium or severe liver injury. The IT-model combining HBsAg level is able to
identify significant fibrosis in the IT-phase CHB patients.
Da-Wu Zeng is currently working at Fujian Medical Uni-
versity, China.
BIOGRAPHY