Lower MELD Scores Linked to Transplant-Free Survival in Hepatitis B Patients

Terry Cheuk-Fung Yip, PhD

It is well-known that Improvement in (MELD) scores during antiviral treatment is related to reduced hepatic decompensation and death in chronic hepatitis B (CHB) patients.

A team, led by Terry Cheuk-Fung Yip, PhD, Faculty of Medicine, Institute of Digestive Disease at The Chinese University of Hong Kong, Shatin, identified the factors linked to transplant-free survival and on-treatment Model for End-Stage Liver Disease (MELD) score improvement for patients with CHB-related cirrhosis.

The investigators identified patients with CHB-related cirrhosis and MELD score ≥ 15 at the start of entecavir and/or tenofovir disoproxil fumarate treatment between 2005-2017.

The team sought a primary endpoint of transplant-free survival after 6 months.

The investigators also sought secondary endpoints at month 5 of transplant-free survival with > 5&#8208;point improvement in MELD score and transplant&#8208;free survival with MELD score < 15.

The study included 999 cirrhotic CHB patients, 605 (60.6%) of which achieved transplant-free survival after 6 months. The proportion of transplant-free survival patients at 6 months stabilized at 10% in patients with high MELD.

The investigators also found patients who achieved transplant-free survival at month 6 were generally younger, with lower MELD scores, lower alanine aminotransferase (ALT), and higher albumin at baseline.

Of the 605 patients with transplant-free survival, 276 (45.6%) achieved > 5&#8208;point improvement in MELD scores. An additional 183 (30.2%) patients had 1-5-point improvements in MELD, while 146 (24.1%) had no improvement or a worsened MELD scores . Also, 321 (53.1%) patients with transplant-free survival had a MELD score < 15 at month 6.

“On top of lower MELD score, patients with CHB&#8208;related cirrhosis who are younger, have higher albumin, and lower ALT are more likely to achieve transplant&#8208;free survival after 6 months of antiviral treatment,” the authors wrote.

Patients with diabetes generally have an increased risk for developing various forms of liver diseases that can cause or exacerbate diabetes, including HBV and hepatitis C virus (HCV) infections. Diabetes can also cause or intensify the severity of liver infections.

In a cross-sectional study, investigators, led by Yihenew Million, University of Gondar, determined the prevalence of both HBV and HCV infections and identified the associated factors among patients with diabetes visiting the University of Gondar referral teaching hospital in Ethiopia between 2016-2017.

The investigators examined 610 patients, half of which had diabetes in the study and found 65 (10.7%) were positive for either hepatitis infection, of which 44 (14.4%) and 21 (6.9%) were positive for at least 1 of the viruses in patients with diabetes and people with no diabetes, respectively.

Out of the diabetic and non-diabetic groups of the study, 26 (8.5%) and 14 (4.6%) (95% CI, .96—4.02) were positive for Hepatitis B virus, respectively, while 23 (7.5%) and 7 (2.3%) (95% CI, 1.46–8.68) of the diabetes and non-diabetic groups were positive for Hepatitis C virus, respectively.

“Positivity for Hepatitis C virus was significantly associated with Type II diabetes,” the authors wrote. “Blood transfusion and unprotected sex were risk factors for Hepatitis B virus infections.”

The study, “Factors associated with improvement in MELD score after antiviral treatment in patients with chronic hepatitis B,” was published online in the Journal of Gastroenterology and Hepatology.