Liver Failure due to Acute Viral Hepatitis (A-E)

Abstract

Background: Viral hepatitis is still one of the key causes of acute liver failure (ALF) in the world. Methods: A selective literature search of the PubMed database was conducted, including current studies, reviews, meta-analyses, and guidelines. We obtained an overview of ALF due to viral hepatitis in terms of epidemiology, course, and treatment options. Results: Most fulminant viral courses are reported after infection with hepatitis A, B, and B/D, but not with hepatitis C. Hepatitis E is also known to cause ALF but has not gained much attention in recent years. However, more and more autochthonous hepatitis E virus infections have been recently observed in Europe. Reactivation of hepatitis B virus (HBV) under immunosuppressive conditions, such as after intensive chemotherapy, is also an increasing problem. For most viral-induced cases of ALF, liver transplantation represented the only therapeutic option in the past. Today, immediate treatment of HBV-induced ALF with nucleotide or nucleoside analogs is well tolerated and beneficially affects the course of the disease. Conclusion: Although numbers in Western European countries are decreasing rapidly, reliable diagnostic screening for hepatitis A-E is necessary to identify the etiology and to determine those most at risk of developing ALF.

Fulminant hepatitis A complicated by Takotsubo syndrome successfully treated with standard volume plasma exchange

“…HAV causes ALF in less than 1% of the cases and is responsible for around 2 to 4% of all ALF cases reported in Western countries, and for 4% and 6% of those reported in Australia and Japan, respectively. 5 Hepatitis A-related ALF has a spontaneous survival rate of 69%; the remaining 31% require emergency liver transplant or die. Around 12% of patients with fulminant hepatitis A listed for emergent liver transplantation show spontaneous improvement and are delisted.…”

Hepatitis A: At-Risk Populations

“…HA results in acute liver failure in less than 1%, age superior to 50 years old and those with underlying liver disease being important risk factors, especially with chronic hepatitis B and C virus infections [37,38]. As a matter of fact, HAV superinfection in patients with underlying chronic liver disease is not also associated with a high risk of liver failure but also of death [37,38].…”

“…Besides, patients with pre-existing liver disease (i.e. non-alcoholic fatty liver disease or alcoholic steatohepatitis) present a higher risk of developing an acute-onchronic liver failure in cases of HAV infection [38,39].…”

How to Define Acute Liver Failure Patients with Pre-Existing Liver Disease without Signs of Cirrhosis

“…ALF itself is one of the most dangerous complications in hepatology, with a high rate of mortality [2,3] and immediate requirement of intensive care [1]. When patients are admitted with the diagnosis of ALF to a tertiary care or liver transplant center, a thorough examination is necessary to identify the underlying cause of ALF and the severity of the situation [4]. Initial diag- nostic tests often reveal either newly diagnosed or already known diabetes, overweight or other previously present but yet undiagnosed risk factors, that is, considerable ethanol consumption, that can affect the normal liver function in these patients.…”