Factors predictive of liver cirrhosis in patients with chronic hepatitis B: a multivariate analysis in a longitudinal study

Objective and design Chronic hepatitis B virus (HBV) infection may lead to liver cirrhosis; however, factors associated with the development of cirrho sis have been incompletely studied. A total of 516 patients with chronic he patitis B were followed up longitudinally to determine their outcome. Methods The clinical and pathological features were compared between those with and without cirrhosis occurrence, The risk factors were analysed, and the probability of the development of cirrhosis was estimated. Results During a mean follow-up period of 5.7 +/- 3.4 years (range 1-17 yea rs), cirrhosis occurred in 71 patients, with a calculated annual incidence of 2.4%. Older age (> 45 years) at entry, male gender, persistent hepatitis (> 1.5-fold rise of serum alanine aminotransferase levels for at least one year) and diabetes mellitus were identified as independent risk factors of cirrhosis in a multivariate analysis (odds ratios 8.0, 19.3, 2.0 and 5.2, respectively; P values all < 0.05). A logistic regression equation was used to predict the probability of cirrhosis occurrence, which was as high as 7 6.6% when all risk factors were present. Acute exacerbation or super-infect ion by hepatitis C or D viruses were not significant predictors. Patients w ith subsequent cirrhosis had higher initial hepatic histological necro-infl ammatory activities when compared to age- and sex-matched non-cirrhotic con trols (Knodell's scores: 8.2 +/- 2.4 versus 6.0 +/- 4.1, P < 0.05). Conclusions Patients who were elderly, male, diabetic or had a history of p ersistent and histologically severe hepatitis were at increased risks of li ver cirrhosis. Aggressive anti-viral therapy may be needed for these patien ts and they should be closely monitored for HBV-related late complications. (C) 2000 Lippincott Williams & Wilkins.