Abstract
Background and Aims: Differentiation of acute viral hepatitis-B (AVH-B) from chronic hepatitis B with acute exacerbation (CHB-AE) is a considerable diagnostic and therapeutic challenge. CHB-AE can lead to ACLF with high mortality and requires urgent treatment. Early recognition is must and there is no gold standard differentiating between the two conditions. We aim to analyse the clinical and laboratory factors differentiating AVH-B from CHB-AE. Materials and Methods: Thirty one patients presenting with acute hepatitis and HBsAg positive status were included in the study. Patient with co-infection with HAV and HEV were excluded. Cases of AVH-B versus CHB-AE labelled on basis of loss of HBsAg after 6 months of follow up. HBV DNA (IU/mL, by Real time PCR) and IgM anti HBc levels (Chemiluminescent microparticle immunoassay, >1 = Reactive) compared in both groups at baseline. [Results: Out of 31 patients 12 were CHB-AE. Mean ALT (IU/L) levels were 749.1 and 1035.5 in CHB-AE and AVH-B group respectively. Mean platelets (109/L) were 222.3 and 229.1 in CHB- AE and AVH-B group respectively. Difference in ALT and platelets levels was statistically non- significant. Mean IgM anti HBc levels were 9.68 and 19.2 in CHB-AE and AVH-B group respectively, was statistically significant [P = 0.008]. Diagnostic accuracy of HBV DNA > 15390 IU/ml had sensitivity of 75% and specificity of 42.1% for CHB-AE. IgM anti HBc level > 10.38 had sensitivity of 78.9% and specificity of 50% for diagnosis of AVH-B. Conclusions: Combination of low IgM anti-HBc titer and high HBV DNA level are useful in diagnosing CHB-AE. The authors have none to declare. TableTabled 1ParametersAVH-BCHB-AEP ValueALT (IU/L)1035.58 (669.05)749.17 (731.47)0.27Total Bilirubin (mg/dl)18.78 (10.32)22.94 (14.94)0.53Serum albumin (gm/dl)3.52 (0.44)2.97 (0.53)0.24Platelets (109/L)229.11 (75.63)222.33 (76.93)0.81HBV DNA (IU/mL)136318.58 (240576.74)19249376.33 (42565326.99)0.058IgM Anti HBc19.20 (10.23)9.68 (6.51)0.008 Open table in a new tab
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