Work

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

Year: 2025

Type: article

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.

Source: World Journal of Gastroenterology

DOI: 10.3748/wjg.v31.i48.114049