BACKGROUND AND AIM: Hepatitis E virus (HEV) is a global disease and an important cause of acute liver failure (ALF) in the Indian subcontinent. The aim of this study was to assess the differences in the course of HEV-ALF as compared to other etiologies of ALF. METHODS: We compared the clinical course, complications, and outcomes of HEV-ALF with other etiologies. We assessed the prognostic factors and compared existing prognostic scores in HEV-ALF patients. RESULTS: One thousand four hundred and sixty-two ALF patients were evaluated between January 1986 and December 2015. HEV was the etiology of ALF in 419 (28.7%) cases, whereas non-A non-E hepatitis, HBV and anti-tuberculosis therapy (ATT) were the etiologies in 527 (36.0%), 128 (8.8%), and 103 (7.0%) cases, respectively. The frequency of cerebral edema in HEV-ALF (41.3%) was lower than that in non-A non-E ALF (52.9%; P < 0.001) and HBV-ALF (52.8%; P = 0.024). Infection and seizures were significantly less in patients with HEV-ALF compared to non-A non-E and HBV-ALF (P = 0.038 and 0.022, respectively). The survival of HEV-ALF patients was significantly better (55.1%, P < 0.001) than patients of other etiologies-including ATT (30.0%), non-A non-E (38.1%) and HBV (35.9%). In HEV-ALF patients, age, female sex, cerebral edema, prothrombin time >60 s, infection, and total bilirubin were observed as independent predictors of outcome on multivariate logistic regression analysis. Model for end-stage liver disease, acute liver failure study group model and King's College Hospital criteria had poor discriminative accuracy for outcome (area under receiver operator characteristic curve 0.63-0.64) in HEV-ALF. CONCLUSIONS: Hepatitis E virus-associated ALF has a better outcome than ALF of other etiologies.
BACKGROUND AND AIM: Hepatitis E virus (HEV) is a global disease and an important cause of acute liver failure (ALF) in the Indian subcontinent. The aim of this study was to assess the differences in the course of HEV-ALF as compared to other etiologies of ALF. METHODS: We compared the clinical course, complications, and outcomes of HEV-ALF with other etiologies. We assessed the prognostic factors and compared existing prognostic scores in HEV-ALFpatients. RESULTS: One thousand four hundred and sixty-two ALFpatients were evaluated between January 1986 and December 2015. HEV was the etiology of ALF in 419 (28.7%) cases, whereas non-A non-E hepatitis, HBV and anti-tuberculosis therapy (ATT) were the etiologies in 527 (36.0%), 128 (8.8%), and 103 (7.0%) cases, respectively. The frequency of cerebral edema in HEV-ALF (41.3%) was lower than that in non-A non-E ALF (52.9%; P < 0.001) and HBV-ALF (52.8%; P = 0.024). Infection and seizures were significantly less in patients with HEV-ALF compared to non-A non-E and HBV-ALF (P = 0.038 and 0.022, respectively). The survival of HEV-ALFpatients was significantly better (55.1%, P < 0.001) than patients of other etiologies-including ATT (30.0%), non-A non-E (38.1%) and HBV (35.9%). In HEV-ALFpatients, age, female sex, cerebral edema, prothrombin time >60 s, infection, and total bilirubin were observed as independent predictors of outcome on multivariate logistic regression analysis. Model for end-stage liver disease, acute liver failure study group model and King's College Hospital criteria had poor discriminative accuracy for outcome (area under receiver operator characteristic curve 0.63-0.64) in HEV-ALF. CONCLUSIONS:Hepatitis E virus-associated ALF has a better outcome than ALF of other etiologies.
Entities:
Keywords:
ALF; Cerebral edema; Hepatitis A virus; Liver transplant; Prognosis
Authors: David G Koch; Holly Tillman; Valerie Durkalski; William M Lee; Adrian Reuben Journal: Clin Gastroenterol Hepatol Date: 2016-04-13 Impact factor: 11.382
Authors: Adrian Reuben; Holly Tillman; Robert J Fontana; Timothy Davern; Brendan McGuire; R Todd Stravitz; Valerie Durkalski; Anne M Larson; Iris Liou; Oren Fix; Michael Schilsky; Timothy McCashland; J Eileen Hay; Natalie Murray; Obaid S Shaikh; Daniel Ganger; Atif Zaman; Steven B Han; Raymond T Chung; Alastair Smith; Robert Brown; Jeffrey Crippin; M Edwyn Harrison; David Koch; Santiago Munoz; K Rajender Reddy; Lorenzo Rossaro; Raj Satyanarayana; Tarek Hassanein; A James Hanje; Jody Olson; Ram Subramanian; Constantine Karvellas; Bilal Hameed; Averell H Sherker; Patricia Robuck; William M Lee Journal: Ann Intern Med Date: 2016-04-05 Impact factor: 25.391
Authors: Robert John Fontana; Ronald E Engle; Steven Scaglione; Victor Araya; Obaid Shaikh; Holly Tillman; Nahid Attar; Robert H Purcell; William M Lee Journal: Hepatology Date: 2016-06-23 Impact factor: 17.425
Authors: Jeffrey D Stanaway; Abraham D Flaxman; Mohsen Naghavi; Christina Fitzmaurice; Theo Vos; Ibrahim Abubakar; Laith J Abu-Raddad; Reza Assadi; Neeraj Bhala; Benjamin Cowie; Mohammad H Forouzanfour; Justina Groeger; Khayriyyah Mohd Hanafiah; Kathryn H Jacobsen; Spencer L James; Jennifer MacLachlan; Reza Malekzadeh; Natasha K Martin; Ali A Mokdad; Ali H Mokdad; Christopher J L Murray; Dietrich Plass; Saleem Rana; David B Rein; Jan Hendrik Richardus; Juan Sanabria; Mete Saylan; Saeid Shahraz; Samuel So; Vasiliy V Vlassov; Elisabete Weiderpass; Steven T Wiersma; Mustafa Younis; Chuanhua Yu; Maysaa El Sayed Zaki; Graham S Cooke Journal: Lancet Date: 2016-07-07 Impact factor: 79.321
Authors: Daniel R Ganger; Jody Rule; Jorge Rakela; Nathan Bass; A Reuben; R T Stravitz; Norman Sussman; Anne M Larson; Laura James; Charles Chiu; William M Lee Journal: Am J Gastroenterol Date: 2018-06-27 Impact factor: 12.045
Authors: Thomas Horvatits; Julian Schulze Zur Wiesch; Marc Lütgehetmann; Ansgar W Lohse; Sven Pischke Journal: Viruses Date: 2019-07-05 Impact factor: 5.048