Clinical, biochemical, immunological and virological profiles of, and differential diagnosis between, patients with acute hepatitis B and chronic hepatitis B with acute flare

• Published in: Journal of gastroenterology and hepatology 2008-11, Vol.23 (11), p.1728-1733
• Main Authors: Han, Yongnian, Tang, Qun, Zhu, Wei, Zhang, Xiaoqing, You, Longying
• Format: Article
• Language: English
• Subjects: Acute Disease; acute hepatitis B; Adult; alpha-fetoprotein; alpha-Fetoproteins - analysis; Biological and medical sciences; Biomarkers - blood; chronic hepatitis B; Diagnosis, Differential; differential diagnosis; DNA, Viral - blood; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis B - diagnosis; Hepatitis B - genetics; Hepatitis B - immunology; Hepatitis B Antibodies - blood; Hepatitis B e Antigens - blood; Hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B virus - immunology; Hepatitis B, Chronic - diagnosis; Hepatitis B, Chronic - genetics; Hepatitis B, Chronic - immunology; Human viral diseases; Humans; Immunoglobulin M - blood; Infectious diseases; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Viral diseases; Viral hepatitis
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2008.05600.x

Background and Aim:  In areas with high or intermediate endemicity for chronic hepatitis B virus (HBV) infection, it is difficult to distinguish acute hepatitis B (AHB) from chronic hepatitis B with an acute flare (CHB‐AF) in patients whose prior history of HBV infection has been unknown. The present study aimed to screen laboratory parameters other than immunoglobulin M antibody to hepatitis B core antigen (IgM anti‐HBc) to discriminate between the two conditions. Methods:  A retrospective and prospective study was conducted in patients first presenting clinically as HBV‐related acute hepatitis to sort out acute self‐limited hepatitis B (ASL‐HB). Then, clinical and laboratory profiles were compared between patients with ASL‐HB and CHB‐AF. Parameters closely associated with ASL‐HB were chosen to evaluate sensitivity, specificity, accuracy, positive predictive values and negative predictive values for diagnosing AHB. Results:  There were significant differences between patients with ASL‐HB and CHB‐AF in relation to clinical and laboratory aspects, with many outstanding differences in levels of serum HBV‐DNA, hepatitis B e antigen (HBeAg) and alpha‐fetoprotein (AFP) as well as IgM anti‐HBc. In particular, there was a greater difference between the two groups in low levels of HBeAg (ratio of the optical density of the sample to the cut‐off value [S/CO]