Significance of anti-HBc IgM in acute hepatitis and hepatitis B associated chronic liver disease.

Introduction: Hepatitis E virus is a major cause of enterically transmitted hepatitis. Mortality is veryhigh if it is associated with pregnancy, especially during third trimester. This study was carried out tofi nd out the effects of acute HEV hepatitis on Chronic Liver Disease patients of different etiologies.Methods: The consecutive patients of liver cirrhosis with defi nite evidence of recent HEV infectionwere enrolled in this study. Acute hepatitis was diagnosed by presence of prodromal symptomsand anti-HEV IgM antibody in their serum. The outcomes after superinfection with HEV hepatitiswere determined by changes in Child Pugh score, recovery of liver function test, hospital stay andmortality.Results: After exclusion 25 were studied. The etiology of cirrhosis in patients was: alcohol 13,autoimmune hepatitis 3, hepatitis B 2, Budd Chiari syndrome 2, alcohol plus hepatitis B 1, hepatitis C1, cardiac cirrhosis 1, Wilson’s disease 1 and cryptogenic 1. All patients with no recent decompensationshowed signs of decompensation during admission. Seven (28%) patients died. The cause of deathwas either upper gastrointestinal bleeding or hepatorenal syndrome. Remaining patients hadprolonged hospital stay with deterioration of Child-Pugh’s score.Conclusions: Superinfection of HEV in cirrhotic patient causes rapid decompensation. The morbidityand mortality is higher compared to those non-infected patients. Development of hepatorenalsyndrome and upper GI bleeding was commonest cause of death.Key Words: acute HEV infection, Chronic liver disease, third trimester pregnancy

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A study of clinical profile and factors affecting mortality in patients with acute on chronic liver failure in a tertiary hospital in north east India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210446 ◽

2021 ◽

Vol 9 (2) ◽

pp. 577

Author(s):

Mallika Bhattacharyya ◽

Narendra Nath Barman ◽

Bhabadev Goswami ◽

Bikash Narayan Choudhury

Keyword(s):

Liver Disease ◽

Hepatitis B ◽

Liver Failure ◽

Acute Hepatitis ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Precipitating Factors ◽

Chronic Liver Failure ◽

North East India ◽

North East

Background: Data regarding Acute on Chronic Liver Failure (ACLF) patients from North East India is scarce and presentation to hospital is often late. We aim to study their clinical profile, aetiology of underlying chronic liver disease, precipitating factors, predictors of mortality and their short term outcome (3 months).Methods: Among 1000 consecutive patients of any form of acute decompensation, 245 patients diagnosed as ACLF were prospectively studied. Comparison was done between survivors versus non survivors of ACLF and between ACLF and Non ACLF patients.Results: Mean age of ACLF patients was 44.2±10.3 years and male:female ratio was 13.4:1. Common causes of underlying cirrhosis in ACLF was alcoholic liver disease, 210 (85.7%), Hepatitis B virus related cirrhosis, 20 (8.2%), Hepatitis C virus related cirrhosis, 6 (2.4%) and cryptogenic in 8 (3.3%). Precipitating causes were alcoholic hepatitis in 98 (46.6%) among alcoholic cirrhosis, acute flare of Hepatitis B infection in 12 patients (60%) among Hepatitis B related cirrhosis, recent use of drugs in 110 (44.8%), sepsis in 71 (28.9%), spontaneous bacterial peritonitis (SBP) in 36 (14.7%), urinary tract infection in 36 (14.7%), acute hepatitis A in 5 (2%) and acute hepatitis E in 3 (1.2%). hepatic encephalopathy, low sodium, high International Normalised Ratio (INR) were found to be significantly associated with high mortality. Increasing number of organ failures is associated with increasing risk of death.Conclusions: ACLF is characterized by rapid deterioration especially when multiorgan failure sets in due to certain precipitating factors in a previously diagnosed or undiagnosed chronic liver disease.

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A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.070 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 37-38

Author(s):

A Zoughlami ◽

J Serero ◽

G Sebastiani ◽

M Deschenes ◽

P Wong ◽

...

Keyword(s):

Platelet Count ◽

Liver Disease ◽

Hepatitis B ◽

Chronic Liver Disease ◽

Esophageal Varices ◽

Diagnostic Performance ◽

Transient Elastography ◽

Chronic Liver ◽

Non Invasive ◽

Chronic Hepatitis B Virus

Abstract Background Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis. Aims We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD. Methods We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM >9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM <20 kPa and platelets >150,000) and expanded Baveno VI criteria (LSM <25 kPa and platelets >110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was >10 kPa. Results A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies. Conclusions These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD. Funding Agencies None

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