Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: a multicentre retrospective study

Abstract

Background: Hepatitis E virus (HEV) is the most common acute viral hepatitis inScotland. Little is known about the burden of morbidity and mortality, which can be high in chronic liver disease or immunocompromised states. Aims:To record the morbidity and mortality of HEV in Scotland. Methods:Demographic, clinical and laboratory data were collected retrospectively from all cases of HEV reported to virology departments across nine NHS health boards, Results: Five hundred and eleven cases were included (Mean age 62, 64% male). 58 (11%) cases had pre-existing cirrhosis and 110 (21%) had diabetes. Three hundred and three patients required admission (59%), totalling 2747 inpatient bed days.Seventeen (3.3%) HEV-related deaths were recorded. Factors that predicted mortality included haematological malignancy (OR 51.56, 95% CI 3.40-782.83, P = 0.005), cirrhosis (OR 41.85, 95% CI 2.85-594.16, P = 0.006), higher serum bilirubin (OR 1.01, 95% CI 1.01-1.02, P = 0.011) and chronic HEV infection (OR 0.02, 95% CI 0.02-0.28, P < 0.001). HEV infection affected 35 transplant patients of 106 total immunosuppressed patients (21%). Of these, 25 patients received Ribavirin therapy with a sustained virological remission of 76%. Thirty-five (6.7%) patients developed acute or acute-on-chronic liver failure with two requiring transplant. Thirty-seven (7.2%) patients reported neurological complications with 10 developing neuralgic amyotrophy, 6 Guillain-Barré and 2 encephalitis. Forty-four (8.6%) patients developed acute kidney injury. Conclusion:In Scotland, HEV causes a significant burden of inpatient admissions, organ failure and death. Cirrhosis and haematological malignancy are significant predictors of mortality. Neurological and renal complications occur in a significant minority. | 975WALLACE Et AL.

Control of Raw Pork Liver Sausage Production Can Reduce the Prevalence of HEV Infection

“…Recent data suggest that the morbidity of HEV infection is higher than previously thought, with a mortality approaching 4% in diagnosed cases [18]. In our cohort, however, only 3 of 375 cases (0.8%) died because of complications directly related to hepatitis E.…”

“…Four of the 55 viraemic patients were initially HEV IgM negative, but seroconverted (IgM+ and IgG+) within 2 weeks. Genotyping was performed in 34 (61%) of the viraemic cases and was successful in 18 Overall, 375/6068 (6.1%) subjects had a serologically confirmed acute HEV infection (Table 2; Figure 2). Of these 375 acute cases, 55 (14.6%) had an HEV infection confirmed by RT-PCR (Table 2, Figure 2).…”

Comparison of detection strategies for screening and confirming congenital cytomegalovirus infection in newborns in a highly seroprevalent population: a mother-child cohort study

“…The Youden index and likelihood ratios are composite index to evaluate diagnostic tests, which were calculated based on the ratio of sensitivity and specificity. Youden index is seen to be the sum of the two fractions showing the proportions correctly diagnosed for newborns with cCMV infection and uninfected newborns, which was measured by the formulation of “sensitivity + specificity-1” [23] . The formula to calculate the positive likelihood ratio was the sensitivity divided by (1 - specificity), and the negative likelihood ratio was as (1 - sensitivity) divided by the specificity [24] .…”

Transfusion-transmitted hepatitis E: What we know so far?

“…A recent meta-analysis concluded that approximately 939 million of the global population have ever experienced HEV infection, and 15 to 110 million individuals have recent or ongoing infection[ 3 ]. The infection is generally self-limiting; however, it poses a threat to some vulnerable patients resulting in a significant burden of in-patient admissions, chronic infection, organ failure, and death[ 4 ]. The mortality rate can be greater than 20% in patients with chronic liver disease, cirrhosis, or pregnancy[ 4 , 5 ].…”

“…The infection is generally self-limiting; however, it poses a threat to some vulnerable patients resulting in a significant burden of in-patient admissions, chronic infection, organ failure, and death[ 4 ]. The mortality rate can be greater than 20% in patients with chronic liver disease, cirrhosis, or pregnancy[ 4 , 5 ]. With a high HEV serological prevalence among the global population, the safety of blood products has become a public health concern.…”