Hepatitis E superinfection produces severe decompensation in patients with chronic liver disease

Ramachandran, Jeyamani; Eapen, CE; Kang, Gagandeep; Abraham, Priya; Hubert, Darius D. J.; Kurian, George; Hephzibah, Julie; Mukhopadhya, Ashis; Chandy, George

doi:10.1111/j.1440-1746.2004.03188.x

Cited by 123 publications

(121 citation statements)

References 8 publications

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“…The identified determinants of such complicated natural course include the specific viral etiology, 20 host factors such as immune competence, age of infection 21 and presence of compensated pre-existing chronic liver disease. [22][23][24][25][26] In the present study, the presence of diabetes has emerged as a risk factor for complicated outcome during an episode of AVH. Two out of 12 diabetics had liver failure and death with a mortality rate of 16.67%.…”

Section: Discussionmentioning

confidence: 99%

Patients with Diabetes Mellitus are Prone to Develop Severe Hepatitis and Liver Failure due to Hepatitis Virus Infection

Singh

Panda

Shalimar

et al. 2013

Journal of Clinical and Experimental Hepatology

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Background: Acute viral hepatitis (AVH) is usually a self-limiting illness. Diabetics are prone to develop liver diseases and liver regeneration is impaired in them. Natural course of AVH in diabetics has not been assessed and may be severe. Design: Observational prospective study to evaluate natural course of AVH in patients with and without diabetes mellitus. Consecutive patients with AVH were included and categorized in to those with or without diabetes. Etiology, complications, mortality and recovery parameters of AVH were identified and compared between two groups. Results: 131 consecutive AVH between March 2007 and March 2009 were evaluated; 12 diabetics and 83 non-diabetics (n = 95) were included for analysis. Hepatitis E was the commonest cause (n = 55, 57.89%) in the whole cohort. However, Hepatitis B virus (HBV) as the etiology was significantly higher among diabetics than in non-diabetics (58.33% vs. 25.3%, P = 0.02). In contrast, hepatitis E was the etiology in 61.44% of non-diabetics. Frequency of severe hepatitis was significantly higher in diabetics than in nondiabetics (5/12; 41.67% vs. 9/83; 10.64%, P < 0.005). 5 of 14 (36%) with severe hepatitis were diabetics. Liver failure and death occurred in 2 (16%) diabetics, while none among the non-diabetics had liver failure. Multiple variable logistic regression analysis revealed that acute hepatitis B (OR 4.7 (95% CI 1.34-16.47)) and diabetes (OR 4.0 (95% CI 0.96-16.47)) were associated with severe hepatitis. Conclusion: Patients with diabetes are at risk to contact HBV infection and severe hepatitis. ( J CLIN EXP HEPATOL 2013;3:275-280)

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Section: Discussionmentioning

confidence: 99%

Patients with Diabetes Mellitus are Prone to Develop Severe Hepatitis and Liver Failure due to Hepatitis Virus Infection

Singh

Panda

Shalimar

et al. 2013

Journal of Clinical and Experimental Hepatology

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“…17 Subsequently, many publications have reported HEV as one of the leading causes for decompensation of cirrhosis from Asia and Africa, where HEV is endemic (Table 1). 14,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Most of these studies have used the APASL definition of ACLF and in median21% of cases (range 4-72%) of ACLF, HEV was the precipitating cause for liver decompensation. This contrasts with the Western countries where HEV is rarely the precipitating cause of acute decompensation in ACLF.…”

Section: Role Of Hepatitis E Virus In Acute-on-chronic Liver Failurementioning

confidence: 99%

Hepatitis E and Acute-on-Chronic Liver Failure

Kumar

Saraswat

2013

Journal of Clinical and Experimental Hepatology

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Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis (AVH) globally. It causes large scale epidemics of AVH across the low-and middle income countries in Asia and Africa, and also causes sporadic cases of AVH in the same geographical region. AVH due to HEV is usually an acute, self-limiting illness, similar in clinical presentation to AVH caused by hepatitis A virus (HAV). When HEV causes AVH in patients of chronic liver disease it may worsen rapidly to a syndrome called acute-on-chronic liver failure (ACLF) leading to very high mortality. Acute deterioration of liver function in a patient with compensated chronic liver disease is the characteristic feature of ACLF. The typical disease course of patients with ACLF is the appearance of organ failure, which progresses to multi-organ failure and death. Many publications have reported HEV as one of the leading causes for ACLF from Asia and Africa, where HEV is endemic. The mortality rate of HEV-related ACLF (HEV-ACLF) ranges from 0% to 67% with a median being 34%. These patients require admission in the intensive care unit and they benefit from a team approach of clinicians with expertise in both hepatology and critical care. The goals of treatment are to prevent further deterioration in liver function, reverse precipitating factors, and support failing organs. Liver transplantation is required in selected patients to improve survival and quality of life. One preliminary report suggests that ribavirin may be an effective and safe drug for treatment of HEV-ACLF however this requires validation in large trials. ( J CLIN EXP HEPATOL 2013;3:225-230)

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“…[8][9][10][11] However, the exclusion of pre-diagnosed CLD patients in enrollment prevented the direct evaluation of the vaccine's safety and immunogenicity in this cohort. There are several other limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Acute-on-chronic disease, which refers to hepatitis with the rapid appearance of signs of liver failure, ascites and encephalopathy in a person with preexisting liver disease, is usually more severe than acute hepatitis and sometimes progresses to fulminant hepatic failure, with a fatality rate of up to 70%. 10,11 Therefore, it is imperative for people with a higher risk of chronic liver disease to become protected against HEV infection.…”

Section: Introductionmentioning

confidence: 99%

Immunogenicity and safety of hepatitis E vaccine in healthy hepatitis B surface antigen positive adults

Huang

Zhu

et al. 2013

Human Vaccines & Immunotherapeutics

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Hepatitis E superinfection produces severe decompensation in patients with chronic liver disease

Cited by 123 publications

References 8 publications

Patients with Diabetes Mellitus are Prone to Develop Severe Hepatitis and Liver Failure due to Hepatitis Virus Infection

Patients with Diabetes Mellitus are Prone to Develop Severe Hepatitis and Liver Failure due to Hepatitis Virus Infection

Hepatitis E and Acute-on-Chronic Liver Failure

Immunogenicity and safety of hepatitis E vaccine in healthy hepatitis B surface antigen positive adults

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