What MELD score mandates use of entecavir for ACLF-HBV HBeAg-negative patients?

AIM: To investigate optimal timing for therapeutic efficacy of entecavir for acute-on-chronic hepatitis B liver failure (ACLF-HBV) in hepatitis B e antigen (HBeAg)negative patients. METHODS: A total of 109 inpatients with ACLF-HBV were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University from October 2007 to October 2010. Entecavir 0.5 mg/d was added to each patient's comprehensive therapeutic regimen. Patients were divided into three groups according to model for end-stage liver disease (MELD) score: high 30, 20 males and 4 females, mean age 47.8 +/- 13.5 years); intermediate (22-30, 49 males and 5 females, 45.9 +/- 12.4 years); and low 22, 28 males and 3 females, 43.4 +/- 9.4 years). Statistical analysis were performed using SPSS 11.0 software. Data with normal distribution were expressed as mean +/- SD and comparisons were made with Student's t tests. A value of P < 0.05 was considered statistically significant. Viral loads were related exponentially and logarithmic data were used for analysis. RESULTS: For 24 patients with MELD score 30, treatment lasted 17.2 +/- 16.5 d. Scores before and after treatment were significantly different (35.97 +/- 4.87 and 40.48 +/- 8.17, respectively, t = -2.762, P = 0.011); HBV DNA load was reduced (4.882 +/- 1.847 copies log(10)/mL to 3.685 +/- 1.436 copies log(10)/mL); and mortality rate was 95.83% (23/24). Of 54 patients with scores of 22-30, treatment lasted for 54.0 +/- 43.2 d; scores before and after treatment were 25.87 +/- 2.33 and 25.82 +/- 13.92, respectively (t = -0.030, P = 0.976); HBV DNA load decreased from 6.308 +/- 1.607 to 3.473 +/- 2.097 copies log(10)/mL; and mortality was 51.85% (28/54). Of 31 patients with scores 22, treatment lasted for 66.1 +/- 41.9 d; scores before and after treatment were 18.88 +/- 2.44 and 12.39 +/- 7.80, respectively, (t = 4.860, P = 0.000); HBV DNA load decreased from 5.841 +/- 1.734 to 2.657 +/- 1.154 copies log(10)/mL; and mortality was 3.23% (1/31). CONCLUSION: For HBeAg-negative patients with ACLF-HBV, when entecavir was added to comprehensive therapy, a MELD score 30 predicted very poor prognosis due to fatal liver failure. (C) 2012 Baishideng. All rights reserved.