Prognostic Significance of End-Stage Liver Diseases, Respiratory Tract Infection, and Chronic Kidney Diseases in Symptomatic Acute Hepatitis E

Symptomatic hepatitis E virus (HEV) infection is sporadic, and usually occurs in a limited number of infected patients, which hinders the investigation of risk factors for clinical outcomes in patients with acute HEV infection. A retrospective cohort study enrolling 1913 patients with symptomatic acute hepatitis E in Beijing 302 Hospital from January 1, 2001 to December 31, 2018 was conducted. The baseline characteristics, clinical features and laboratory data of these HEV infection cases were analyzed. Albumin (ALB), platelet (PLT), alanine aminotransferase (ALT), total bilirubin (T-BiL), international normalized ratio (INR) and serum creatinine (SCR) levels, along with the model for end-stage liver disease (MELD) score, hospitalization days, co-morbidity number and mortality were taken as major parameters for comparing the clinical manifestations in our study. We found that not all pre-existing chronic liver diseases exacerbate clinical manifestations of acute hepatitis E. Alcoholic hepatitis, fatty liver hepatitis, hepatic cyst, drug-induced hepatitis and hepatocellular carcinoma were not significantly associated with mortality of HEV patients. Among all of the comorbidities, end-stage liver diseases (ESLDs, including ascites, cirrhosis, hepatic coma and hepatorenal syndrome), respiratory tract infection and chronic kidney diseases (CKDs, including renal insufficiency and renal failure) were found to remarkably increase the mortality of patients with symptomatic HEV infection. Furthermore, the severity evaluation indexes (SEI), such as MELD score, duration of hospital stay, and co-morbidity number in HEV patients with underlying comorbidities were much worse than that of their counterparts without relevant comorbidities.

Download Full-text

Epidemiological and virological characteristics of symptomatic acute hepatitis E in Greater Cairo, Egypt

Clinical Microbiology and Infection ◽

10.1111/j.1469-0691.2011.03727.x ◽

2012 ◽

Vol 18 (10) ◽

pp. 982-988 ◽

Cited By ~ 18

Author(s):

E. Delarocque-Astagneau ◽

F. Abravanel ◽

A. Moshen ◽

L. Le Fouler ◽

R.R. Gad ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis E ◽

Greater Cairo ◽

Acute Hepatitis E ◽

Symptomatic Acute Hepatitis

Download Full-text

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

Pathogens ◽

10.3390/pathogens9100832 ◽

2020 ◽

Vol 9 (10) ◽

pp. 832

Author(s):

Claudia Minosse ◽

Elisa Biliotti ◽

Daniele Lapa ◽

Alessia Rianda ◽

Mauro Marchili ◽

...

Keyword(s):

Viral Load ◽

Acute Hepatitis ◽

Epigastric Pain ◽

Clinical Manifestations ◽

Clinical Information ◽

Hepatitis E ◽

International Normalized Ratio ◽

Genotype 3 ◽

Lazio Region ◽

Acute Hepatitis E

Genotype 3 (GT3) is responsible for most European autochthonous hepatitis E virus (HEV) infections. This study analyzed circulating genotypes and GT3 subtypes in the Lazio region, Italy, between 2011 and 2019, as well as their pathogenic characteristics. Of the 64 evaluable HEV GT3 patient-derived sequences, identified subtypes included GT3f (n = 36), GT3e (n = 15), GT3c (n = 9), GT3a (n = 1) and three unsubtyped GT3 sequences. GT3c strains were similar to Dutch sequences (96.8–98.1% identity), GT3e strains showed high similarity (96.8%) with a United Kingdom sequence, while the most related sequences to GT3f Italian strains were isolated in France, Belgium and Japan. One sequence was closely related to another Italian strain isolated in raw sewage in 2016. The liver functioning test median values for 56 evaluable GT3 patients were: alanine aminotransferase (ALT), 461 (range 52–4835 U/L); aspartate aminotransferase (AST), 659 (range 64–6588 U/L); and total bilirubin, 3.49 (range 0.4–33 mg/dL). The median HEV RNA viral load for 26 evaluable GT3 patients was 42,240 IU/mL (range 5680–895,490 IU/mL). Of the 37 GT3 patients with available clinical information, no correlation was observed between HEV clinical manifestations and GT3 subtype. HEV symptoms were comparable among GT3c/e/f patients across most analyzed categories except for epigastric pain, which occurred more frequently in patients with HEV GT3e (75%) than in patients with GT3c (50%) or GT3f (19%) (p = 0.01). Additionally, patients with HEV GT3c exhibited significantly higher median international normalized ratio (INR) than patients with GT3e and GT3f (p = 0.033). The severity of GT3 acute hepatitis E was not linked to HEV RNA viral load or to the GT3 subtype.

Download Full-text

Poor Outcomes of Acute Hepatitis E in Patients With Cirrhotic Liver Diseases Regardless of Etiology

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa107 ◽

2020 ◽

Vol 7 (4) ◽

Author(s):

Yijin Wang ◽

Hongyang Liu ◽

Yiyun Jiang ◽

Qiuwei Pan ◽

Jingmin Zhao

Keyword(s):

Acute Hepatitis ◽

Liver Diseases ◽

Hepatitis E Virus ◽

Hepatitis E ◽

Adverse Outcomes ◽

Chronic Liver Diseases ◽

Predominant Role ◽

Acute Hepatitis E ◽

Poor Outcomes

Abstract Background: Chronic liver diseases (CLDs) have been documented to exacerbate clinical outcomes of acute hepatitis E (AHE). This study aimed to uncover the role of etiology and status of CLD in the adverse outcomes of AHE. We found that superinfection with hepatitis E virus (HEV) in patients with cirrhotic CLD can cause a worsen outcome, leading to exacerbation of AHE, compared with HEV-infected patients without CLD or with noncirrhotic CLD. Additional analysis revealed that the etiology of CLD is not associated with outcomes of AHE patients. These finding suggests that the overall liver status plays a predominant role in determining the outcomes of AHE.

Download Full-text

Comparison of clinical manifestations and epidemiology between acute hepatitis A and acute hepatitis E in Taiwan

Journal of Gastroenterology and Hepatology ◽

10.1046/j.1440-1746.2002.02858.x ◽

2002 ◽

Vol 17 (11) ◽

pp. 1187-1191 ◽

Cited By ~ 11

Author(s):

Chien-Wei Su ◽

Jaw-Ching Wu ◽

Yi-Shin Huang ◽

Teh-Ia Huo ◽

Yi-Hsiang Huang ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis A ◽

Clinical Manifestations ◽

Hepatitis E ◽

Acute Hepatitis A ◽

Acute Hepatitis E

Download Full-text

Lower Levels of Transaminases but Higher Levels of Serum Creatinine in Patients with Acute Hepatitis E in Comparison to Patients with Hepatitis A

Pathogens ◽

10.3390/pathogens10010060 ◽

2021 ◽

Vol 10 (1) ◽

pp. 60

Author(s):

Thomas Theo Brehm ◽

Omid Mazaheri ◽

Thomas Horvatits ◽

Marc Lütgehetmann ◽

Julian Schulze zur Wiesch ◽

...

Keyword(s):

Serum Creatinine ◽

Acute Hepatitis ◽

Hepatitis A ◽

Medical Center ◽

Hepatitis E ◽

Distribution Width ◽

Lymphocyte Ratio ◽

Median Serum ◽

Acute Hepatitis E ◽

Hematological Manifestations

In patients with hepatitis E virus (HEV) infections, extrahepatic, particularly renal and hematological manifestations, are increasingly reported in the medical literature but have never been studied compared to a control cohort. We retrospectively analyzed medical records of consecutive patients that were diagnosed with acute hepatitis E (AHE) (n = 69) or acute hepatitis A (AHA) (n = 46) at the University Medical Center Hamburg Eppendorf from January 2009 to August 2019 for demographical, clinical, and laboratory information. Patients with AHE had significantly lower median levels of ALAT (798 U/L) and total bilirubin (1.8 mg/dL) compared to patients with AHA (2326 U/L; p < 0.001 and 5.2 mg/dL; p < 0.001), suggesting a generally less severe hepatitis. In contrast, patients with AHE had significantly higher median serum creatinine levels (0.9 mg/dL vs. 0.8 mg/dL; p = 0.002) and lower median estimated glomerular filtration rate (eGFR) (91 mL/min/1.73 m2 vs. 109 mL/min/1.73 m2; p < 0.001) than patients with AHA. Leucocyte, neutrophil and lymphocyte count, hemoglobin, platelets, red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and RDW to lymphocyte ratio (RLR) did not differ between patients with AHE and those with AHA. Our observations indicate that renal but not hematological interference presents an underrecognized extrahepatic feature of AHE, while inflammation of the liver seems to be more severe in AHA.

Download Full-text