Clinical, pathological characteristics and long-term outcomes of hepatitis B virus related cirrhosis in pediatric observational study

Abstract

BACKGROUND

Chronic hepatitis B virus (HBV) infection acquired in childhood frequently presents with mild or nonspecific symptoms, yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis (LC) before adulthood.

AIM

To identify clinical and pathological characteristics of pediatric HBV-related LC.

METHODS

A total of 1332 pediatric patients with chronic HBV infection from the Fifth Medical Center of PLA General Hospital from January 2010 to January 2023 were included in this study. We identified 62 pediatric HBV-related LC by liver biopsy from the group. Subsequently, we described the clinical and pathological characteristics of pediatric LC. And 64 pediatric chronic hepatitis B (CHB; age and sex were matched with pediatric LC group) and 69 adult HBV-related LC (sex were matched with pediatric LC group) were enrolled to further demonstrate clinical and pathological differences between pediatric LC, pediatric CHB and adult LC.

RESULTS

We enrolled 62 pediatric LC, including 54 (87.1%) males and 8 (12.9%) females. The median age was 11 (4-14) years old. The pediatric LC group showed significantly lower median quantitative HBV DNA loads (log₁₀IU/mL: 6.3 vs 17.4, P < 0.001), reduced HBsAg titers (log₁₀IU/mL: 3.11 vs 8.956, P < 0.0001), and diminished hepatitis B e antigen-positive positive rate (81.4% vs 93.8%, P < 0.05) compared with pediatric CHB. A higher proportion of pediatric patients were asymptomatic (77.4%) compared to adult patients (11.6%) as they first diagnosed as LC, pediatric LC showed milder initial symptoms compared with adult patients such as fatigue (4.8% vs 27.5%), abdominal discomfort (9.7% vs 23.2%), nausea (0% vs 10.1%), and poor appetite (6.5% vs 8.7%; all P < 0.0001). Notably, pediatric LC can achieve a significant percentage of functional cure compared with adult LC as 17.4% and 0%. The incidence of progression of LC in children after antiviral therapy continues to be much lower than that in adult LC (hazard ratio = 6.102, 95% confidence interval: 1.72-21.65, P = 0.00051). While the incidence of LC remission in children after antiviral therapy continues to be much higher than that in adult LC (hazard ratio = 0.055, 95% confidence interval: 0.07128-0.2802, P < 0.0001).

CONCLUSION

Pediatric patients with HBV-related cirrhosis exhibit elevated virological parameters and heightened transaminase levels than adult patients. However, the frequent paucity of overt clinical symptoms contributes to diagnostic challenges. Notably, early initiation of antiviral therapy in this population substantially improved clinical outcomes.

Keywords: Pediatric; Hepatitis B virus; Liver cirrhosis; Clinical; Pathological

Core Tip: Pediatric cirrhosis is mostly detected via physical examination with rare symptoms, whereas adults typically present with jaundice, hematochezia, and fatigue. Pediatric cirrhosis has a better prognosis than adult cases, with higher hepatitis B surface antigen seroclearance rates and potential rapid reversal in some instances, while adult cirrhosis generally carries a poor prognosis. Pediatric cirrhosis progresses more rapidly (even occurring in children < 3 years old), whereas adult cases follow a slower clinical course. Children with cirrhosis often have a history of liver dysfunction and frequently experience disease recurrence due to self-discontinuation of hepatoprotective/antiviral/traditional Chinese medicine treatments.