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Establishment of a prognostic model for clinical relapse after drug withdrawal in chronic hepatitis B patients with hepatitis B e antigen seroconversion

Objective 
To investigate the prognostic factors for clinical relapse in chronic hepatitis B (CHB) patients with hepatitis B e antigen (HBeAg) seroconversion after drug withdrawal and to establish a prognostic model. 
 
 
Methods 
Totally 201 CHB patients with HBeAg seroconversion after the antiviral therapy were enrolled. The epidemiological variables including age, gender and family history of hepatitis B were collected. Liver function and hepatitis B virus (HBV) DNA level one week before initiation of antiviral therapy, hepatitis B surface antigen (HBsAg) level at the time of drug withdrawal and the duration of antiviral therapy after HBeAg seroconversion were analyzed. The clinical relapse after 48 weeks of drug withdrawal was followed up. The patients were divided into relapse group and non-relapse group according to clinical variables at 48 weeks after drug withdrawal. The counting data were analyzed by chi-square test and the measurement data were analyzed by t test. The Logistic regression model was used to determine the prognostic factors for clinical relapse. The receiver operating charactenstic (ROC) curve was constructed to assess the performance of the prediction model. 
 
 
Results 
The clinical relapse rate was 16.42% (33/201) after 48 weeks of drug withdrawal. By multivariate analysis, age, the duration of antiviral therapy after HBeAg seroconversion and HBsAg level at the time of drug withdrawal were independent predictors (χ2=14.546, t=3.202, t=3.286, respectively; all P<0.05). The regression model Logit (P)=1.220×age-0.040×the duration of antiviral therapy after HBeAg seroconversion + 0.004×HBsAg level at the time of drug withdrawal -5.426. The sensitivity and specificity with the cut-off value of -0.860 were 73.10% and 90.40%, respectively. 
 
 
Conclusions 
Age, the duration of antiviral therapy after HBeAg seroconversion and HBsAg level at the time of drug withdrawal are independent predictors for clinical relapse 48 weeks after drug withdrawal in CHB patients with HBeAg seroconversion after antiviral therapy. 
 
 
Key words: 
HBeAg seroconversion; Clinical relapse; Prognostic model; Logistic regression analysis