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HBV-infected patients died most often of hepatitis B-related issues

Patients infected with hepatitis B most commonly died of related causes, with advanced age increasing the risk for hepatitis-related mortality, according to recent results.

Researchers evaluated data from 6,689 patients (3,445 males and 3,244 females) with hepatitis B from March 1996 through December 2005. Mortality rates were determined, with deaths grouped according to causes including HBV-related issues, cancer, cardiovascular problems or other/unknown causes. HBV-related causes were subdivided into decompensated cirrhosis (DCC) or hepatocellular carcinoma (HCC). DCC was defined as ascites, portal hypertension or hepatic encephalopathy.

Four hundred thirty-nine patents died during the study, including 307 males, for an overall mortality rate of 7.5 per 1,000 person-years. Death was related to HBV in 205 cases (165 males). Mortality rates were higher among males than females overall (8.9% vs. 4.1%) and for HBV-related causes (4.8% vs. 1.2%).

Deaths from HCC — twice as common as deaths in males from all other cancers combined — represented 70% of cancer deaths among males and 37% among females. Death from HCC was twice as common as DCC-related mortality among patients who died of HBV.

Multivariate analysis indicated that advanced age, male sex and pre-existing comorbidities, including kidney disease, cancer, diabetes or cardiovascular disease, were predictive of all-cause mortality. Only advanced age was predictive of HBV-related mortality for males (OR=7.8, 3.9-15.5, aged 40 to 64 years; OR=34.4, 16.3-72.6, aged 65 years and older) and females (OR=11.4, 2.7-48.5; OR=50, 10.7-233.7, respectively) (95% CI for all).

“Hepatitis B was a major cause of mortality in those infected with HBV and this mortality increased dramatically with increasing age,” the researchers concluded. “Of note … those with hepatitis B die more often from HCC than from all other cancers put together. This has implications for the priority that should be given to age-appropriate HCC screening in this population. Even more important are the appropriate screening for HBV in high-risk populations, appropriate use of anti-HBV medications, and ultimate eradication of this disease through universal HBV vaccination.”