Acute exacerbations of chronic hepatitis B (CHB-AEs) are commonly encountered in endemic areas. These are often considered as acute hepatitis B (AHB) owing to the similarities in clinical and serological aspects, thus posing a major diagnostic dilemma.

A study by researchers at the Institute of Liver and Biliary Sciences, Delhi, India, sought to determine laboratory markers in order to differentiate between the two groups. The study also aimed to ascertain the cut-off value for significant markers.

Investigators carried out a retrospective analysis of records for patients presenting with clinical features of acute hepatitis with hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity from May 2015 through May 2017. In all, 172 patients were recruited. Patients were segregated into AHB (n=89) and CHB-AE (n=83) groups on the basis of their history of hepatitis B virus infection and duration of HBsAg persistence. Investigators assessed the virological and biochemical parameters. Cut-off values, sensitivity, and specificity of the variables were calculated.

The median value of signal by cut-off (S/Co) ratio for IgM anti-HBc was found to be significantly higher in AHB group (30.44) compared to CHB-AE group (8.63), with a sensitivity and specificity of 97% and 84%, respectively, at a cut-off of 20.5 (P<0.01). The CHB-AE group had significantly greater mean international normalized ratio (INR) (1.88±1.24) compared to AHB group (1.62±0.17), with a sensitivity and specificity of 57.9% and 45.1%, respectively, at a cut-off value of 1.27.

To conclude, a value of 20.5 S/Co of IgM anti-HBc and 1.27 INR could assist the differentiation between AHB and CHB-AE.

Source: Lall S, Agarwala P, Kumar G, et al. The Dilemma of Differentiating Between Acute Hepatitis B and Chronic Hepatitis B With Acute Exacerbation: Is Quantitative Serology the Answer? Clin Mol Hepatol. 2020 Apr;26(2):187-195.