Indicators of Severe Outcomes in Chronic Hepatitis B Patients

There is a vaccine that prevents hepatitis B, and most people who do contract the virus recover in fewer the 6 months. However, approximately 1.59 million people live with chronic hepatitis B virus (HBV) in the US.

HBV infection is most prevalent among men and non-Hispanic Asians adults. For some people, chronic HBV may devolve to liver damage, cirrhosis, hepatocellular carcinoma, or death.

One study, presented at the recent IDWeek conference, wanted to examine factors that could predict which people living with chronic HBV develop severe or fatal infection.

The investigators analyzed electronic health records from adult members of Kaiser Permanente Southern California, including those with at least 1 year of continuous membership during the 2008-2019 study period. They included adults with 2 successive, positive, lab-confirmed HBV lab tests administered at least 6 months apart, results which supported a diagnosis of chronic HBV.

Severe outcomes of interest included hepatic decompensation, hepatocellular carcinoma (HCC), liver transplant, liver cirrhosis, and death. For each of these outcomes, the investigators reported demographic information, including age, sex, race, and ethnicity, as well as relevant lab values.

The final study population included 5427 patients diagnosed with chronic hepatitis B. The cohort had 411 (7.6%) cases of liver cirrhosis, 123 (2.3%) of hepatic decompensation, 65 (1.2%) of HCC, 8 (0.1%) of liver transplant, and 164 (3.0%) deaths.

When the investigators evaluated demographics, they found the patients with severe outcomes were typically older than the rest of the cohort; the average age among all study patients was 47 years, but those who developed severe outcomes had a median age of > 50 years.

The participants with severe outcomes were also > 56% male and Asian. Diabetes coinfection was recorded among 25% of patients with hepatic decompensation, HCC, and death, compared to 8% of the overall cohort. Among the patients with liver cirrhosis, diabetes was twice as prevalent.

The investigators concluded the characteristics and demographics of those patients with severe outcomes was consistent with that observed overall in chronic hepatitis B patients. However, the 2-3 times higher rate of diabetes in patients with severe outcomes is significant and merits further study. The study authors concluded, “Identifying characteristics that are more prevalent in those with severe outcomes can help inform screening and management of chronic hepatitis B.”