{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:04:50Z","timestamp":1785168290072,"version":"3.55.0"},"reference-count":31,"publisher":"The Korean Association for the Study of the Liver","issue":"2","license":[{"start":{"date-parts":[[2020,4,7]],"date-time":"2020-04-07T00:00:00Z","timestamp":1586217600000},"content-version":"tdm","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["e-cmh.org"],"crossmark-restriction":true},"short-container-title":["Clin Mol Hepatol"],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:p>Background\/Aims: Acute exacerbations of chronic hepatitis B (CHB-AEs) are common in endemic areas and are often presumed to be acute hepatitis B (AHB) due to their similarities in clinical and serological pictures, presenting a major diagnostic dilemma. This study aimed to identify laboratory markers for differentiating between the two groups, and to establish the cut-off value for significant markers.&lt;br\/&gt;Methods: A retrospective analysis of records was conducted for patients who presented with clinical features of acute hepatitis along with hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity from May 2015 to May 2017. A total of 172 patients were enrolled and grouped as AHB (n=89) and CHB-AE (n=83) based on their history of hepatitis B virus infection and duration of HBsAg persistence. Virological and biochemical parameters were analyzed and compared. Cut-off values, sensitivity, and specificity of the variables were calculated.&lt;br\/&gt;Results: The median value of signal by cut-off (S\/Co) ratio for IgM anti-HBc was 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&lt;0.01). The mean international normalized ratio (INR) was significantly greater in CHB-AE (1.88\u00b11.24) group compared to AHB group (1.62\u00b10.17) with a sensitivity and specificity of 57.9% and 45.1%, respectively, at a cut-off value of 1.27.&lt;br\/&gt;Conclusions: A value of 20.5 S\/Co of IgM anti-HBc and 1.27 INR could be helpful in differentiating between AHB and CHB-AE. 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