BACKGROUND/AIMS: Hepatitis A is usually a mild, self-limiting illness but can result in severe or fatal disease. We reviewed 25 years experience to determine what factors predispose to severe or fatal disease. METHODOLOGY: We identified 97 patients admitted between 1974-1999 with acute hepatitis A. Clinical, biochemical and histological data were correlated with outcome and patients were screened for evidence of hepatitis B or C virus coinfection and coexisting autoimmunity. RESULTS: Fifty-five patients had liver failure with hepatic encephalopathy of whom 29 died and 6 underwent liver transplantation. Patients with liver failure were significantly older than those without (mean age: 42.2 +/- 13.3 vs. 29.2 +/- 7.8, P = 0.0001), and liver failure patients who died were older than those surviving (47.5 +/- 12.7 vs. 36.3 +/- 11.6, P = 0.0001). Hyperacute liver failure predicted good outcome (P = 0.0001). Three patients with viral coinfection had established cirrhosis and died. Detectable autoantibodies did not correlate with outcome or severity. Patients acquiring infection abroad were more likely to have liver failure than those acquiring infection in the UK (P = 0.023). CONCLUSIONS: Age is the best predictor for outcome in patients with liver failure from hepatitis A. Underlying chronic liver disease, and the time of onset of encephalopathy are also factors affecting outcome. Infection acquired abroad has a worse prognosis.
BACKGROUND/AIMS: Hepatitis A is usually a mild, self-limiting illness but can result in severe or fatal disease. We reviewed 25 years experience to determine what factors predispose to severe or fatal disease. METHODOLOGY: We identified 97 patients admitted between 1974-1999 with acute hepatitis A. Clinical, biochemical and histological data were correlated with outcome and patients were screened for evidence of hepatitis B or C virus coinfection and coexisting autoimmunity. RESULTS: Fifty-five patients had liver failure with hepatic encephalopathy of whom 29 died and 6 underwent liver transplantation. Patients with liver failure were significantly older than those without (mean age: 42.2 +/- 13.3 vs. 29.2 +/- 7.8, P = 0.0001), and liver failurepatients who died were older than those surviving (47.5 +/- 12.7 vs. 36.3 +/- 11.6, P = 0.0001). Hyperacute liver failure predicted good outcome (P = 0.0001). Three patients with viral coinfection had established cirrhosis and died. Detectable autoantibodies did not correlate with outcome or severity. Patients acquiring infection abroad were more likely to have liver failure than those acquiring infection in the UK (P = 0.023). CONCLUSIONS: Age is the best predictor for outcome in patients with liver failure from hepatitis A. Underlying chronic liver disease, and the time of onset of encephalopathy are also factors affecting outcome. Infection acquired abroad has a worse prognosis.
Authors: Anke Oltmann; Stephanie Kämper; Oliver Staeck; Jonas Schmidt-Chanasit; Stephan Günther; Thomas Berg; Christina Frank; Detlev H Krüger; Jörg Hofmann Journal: J Clin Microbiol Date: 2008-09-03 Impact factor: 5.948