Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3953-3959
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3953
Differentiation of acute and chronic hepatitis B in IgM anti-HBc positive patients
Ji Won Park, Kyeong Min Kwak, Sung Eun Kim, Myoung Kuk Jang, Dong Joon Kim, Myung Seok Lee, Hyoung Su Kim, Choong Kee Park
Ji Won Park, Sung Eun Kim, Choong Kee Park, Department of Internal Medicine, Hallym University Medical Center, Anyang 431-070, South Korea
Kyeong Min Kwak, Department of Occupational and Environmental Medicine, Hallym University Medical Center, Anyang 431-070, South Korea
Myoung Kuk Jang, Myung Seok Lee, Hyoung Su Kim, Department of Internal Medicine, Hallym University Sacred Heart Hospital of Hallym University Medical Center, Seoul 134-701, South Korea
Dong Joon Kim, Department of Internal Medicine, Hallym University Medical Center, Chuncheon 200-704, South Korea
Author contributions: Kim HS and Park CK designed the research; Park JW, Kim SE, Jang MK, Kim DJ and Lee MS performed the research; Park JW, Kwak KM and Kim HS analyzed the data; Park JW wrote the paper.
Supported by Hallym University Medical Center No. HURF-2013-31.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hyoung Su Kim, MD, Department of Internal Medicine, Hallym University Sacred Heart Hospital of Hallym University Medical Center, 445, Gildong, Kangdong-gu, Seoul 134-701, South Korea. hskim@hallym.or.kr
Telephone: +82-2-22252889 Fax: +82-2-4786925
Received: August 16, 2014
Peer-review started: August 17, 2014
First decision: September 15, 2014
Revised: October 7, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: April 7, 2015
Processing time: 234 Days and 4.4 Hours
Abstract

AIM: To identify the factors that differentiate acute hepatitis B (AHB) from chronic hepatitis B with acute exacerbation (CHB-AE).

METHODS: From 2004 to 2013, a total of 82 patients (male n = 52, 63.4%; female n = 30, 36.6%) with clinical features of acute hepatitis with immunoglobulin M antibodies to the hepatitis B core antigen (IgM anti-HBc) were retrospectively enrolled and divided into two groups; AHB (n = 53) and CHB-AE (n = 29). The AHB group was defined as patients without a history of hepatitis B virus (HBV) infection before the episode and with loss of hepatitis B surface antigen within 6 mo after onset of acute hepatitis. Biochemical and virological profiles and the sample/cutoff (S/CO) ratio of IgM anti-HBc were compared to determine the differential diagnostic factors.

RESULTS: The multivariate analysis demonstrated that, the S/CO ratio of IgM anti-HBc and HBV DNA levels were meaningful factors. The S/CO ratio of IgM anti-HBc was significantly higher in the AHB group, while the HBV DNA level was significantly higher in the CHB-AE group. The optimal cutoff values of IgM anti-HBc and HBV DNA levels for differentiating the two conditions were 8 S/CO ratio and 5.5 log10 IU/mL, respectively. The sensitivity and specificity were 96.2% and 89.7% for the S/CO ratio of IgM anti-HBc and 81.1% and 72.4% for HBV DNA levels, respectively. The area under receiver operating characteristic curves of both the S/CO ratio of IgM anti-HBc and HBV DNA levels were not significantly different (0.933 vs 0.844, P = 0.105). When combining IgM anti-HBc and HBV DNA, the diagnostic power significantly improved compared to HBV DNA alone (P = 0.0056). The combination of these factors yielded a sensitivity and specificity of 98.1% and 86.2%, respectively.

CONCLUSION: The combination of the S/CO ratio of IgM anti-HBc and HBV DNA levels was a useful tool for differentiating AHB from CHB-AE in patients with positive IgM anti-HBc.

Keywords: Acute hepatitis; Differential diagnosis; Chronic hepatitis; Hepatitis B virus

Core tip: Distinguishing between acute hepatitis B (AHB) and chronic hepatitis B with acute exacerbation (CHB-AE) is important because of the different prognosis and treatment strategy. However, distinguishing AHB and CHB-AE is difficult due to their similar clinical features and serologic profiles, especially in patients with IgM anti-HBc positivity. This is the first study to differentiate between AHB and CHB-AE in a distinct group of subjects with positive IgM anti-HBc. The quantitative determination of IgM anti-HBc was useful for differentiating AHB from CHB-AE in patients IgM anti-HBc positive. The combination of serum IgM anti-HBc ≥ 8 S/CO ratio with HBV-DNA levels < 5.5 log10 IU/mL could effectively distinguish AHB from CHB-AE.