Serum hepatitis B surface antigen level might predict cirrhosis and hepatocellular carcinoma in older patients with chronic hepatitis B

Summary Background and aim Distinguishing inactive hepatitis B surface antigen (HBsAg) carriers from hepatitis B e antigen‐negative hepatitis remains difficult but is important because patients with active hepatitis may develop severe complications. Long‐term follow‐up data with stringent criteria are required for the identification of inactive HBsAg carriers. A single serum HBsAg level may be used to solve this difficult diagnostic issue; however, very few studies on its application in older patients have been published. This study was designed to evaluate the clinical significance of a single serum HBsAg level in older patients with chronic hepatitis B (CHB). Materials and methods From January 2012 to December 2012, the clinical manifestations of 1749 HBsAg‐positive patients were analyzed including 412 patients aged ≥ 60 years (mean age at enrollment, 68.6 ± 6.9 years; range, 60–90 years; 262 males and 150 females). We investigated the possibility of using a single serum HBsAg level to predict cirrhosis and hepatocellular carcinoma (HCC) in older patients with CHB. Results Of the 1749 HBsAg‐positive patients, those aged ≥ 60 years tended to have lower serum HBsAg levels than the younger patients. In fact, all patients aged ≥ 60 years had a serum HBsAg level ≤ 10,000 IU/mL. Of the 412 patients aged ≥ 60 years, 122 (29.6%) had cirrhosis and 59 (14.3%) developed HCC. When an HBsAg‐titer < 100 IU/mL was used to examine severe clinical outcomes (cirrhosis or HCC), the sensitivity, specificity, positive predictive value, and negative predictive value for being free of liver cirrhosis and HCC were 49.3% and 95.2%, 19.7% and 28.8%, 85.6% and 95.2%, and 40.0% and 71.2%, respectively. Conclusion A single serum HBsAg level < 100 IU/mL might predict favorable clinical results in older patients with late‐stage CHB virus infection.