Acute viral hepatitis B with bridging necrosis: a follow‐up study

Abstract

ABSTRACT— Forty patients with bridging necrosis (BN) on biopsies taken during the course of acute viral hepatitis B were included in a prospective study to assess the prognostic significance of this lesion. Of the 22 patients with complete clinical, biochemical and histological follow‐up (histological follow‐up 5–33 months), only two failed to eliminate HBs‐ and HBe‐antigen in serum, a finding paralleled by transition to chronic active hepatitis and by the persistence of focal HBc‐ and HBs‐antigen expression in liver tissue. Nineteen of 22 patients showed complete histological healing; one developed inactive cirrhosis. It is concluded that, in the setting of acute viral hepatitis B, the histological lesion of BN is of no particular prognostic significance, and that transition to chronic liver disease is much less frequent than has been assumed from previous studies of etiologically heterogeneous patient populations. Markers of poor prognosis are the failure of serological elimination of HBs‐ and HBe‐antigen and the persistence of spotty expression of HBc‐ and HBs‐antigen on immunofluorescence histology.

The prognostic significance of bridging hepatic necrosis in chronic type B hepatitis: a histopathologic study

“…This histopathologic follow-up study provides statistical support to the prognostic importance of BHN in patients with chronic HB as there was a four-fold increased risk for cirrhotic progression in the BHN group when compared to the SN group. This is apparently different from that of acute hepatitis B in which BHN has a low cirrhotic progression rate and thus has no particular prognostic significance (4,8). BHN was not an uncommon event in this group of chronic HB patients with acute exacerbation.…”