Clinical features and risk factors of acute hepatitis E with severe jaundice

Yu LIU; Xue MEI; Yuyi ZHANG; Ying ZOU; Zhengguo ZHANG; Hongying GUO; Wei YUAN; Jiefei WANG; Zhiping QIAN

doi:10.3969/j.issn.1001-5256.2021.03.013

Volume 37 Issue 3

Mar. 2021

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Article Navigation > Journal of Clinical Hepatology > 2021 > 37(3): 565-569

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Clinical features and risk factors of acute hepatitis E with severe jaundice

DOI: 10.3969/j.issn.1001-5256.2021.03.013

Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai 201508, China

Received Date: 2020-09-02
Accepted Date: 2020-09-17
Published Date: 2021-03-20

Abstract

Abstract

Objective To investigate the clinical features of acute hepatitis E (AHE) patients with or without severe jaundice and the risk factors for severe jaundice. Methods A retrospective analysis was performed for the clinical data of 179 AHE patients who were admitted to Shanghai Public Health Clinical Center Affiliated to Fudan University from January 1, 2018 to March 26, 2020. According to whether total bilirubin (TBil) was > 171 μmol/L, the patients were divided into AHE-mild jaundice (AHE-M) group and AHE-severe jaundice (AHE-S) group, and the two groups were compared in terms of clinical data and laboratory markers. The t test or the Mann-Whitney U test or the chi-squared test was used for comparison, and a binary logistic regression analysis was used to identify independent risk factors. Results Of all 179 patients, 101 (56.42%) were found to have severe jaundice. Compared with the AHE-M group, the AHE-S group had a significantly higher proportion of male patients (80.20% vs 61.54%, χ²=7.612, P=0.006), a significantly longer length of hospital stay [29 (19-45) days vs 18 (14-22) days, Z=-6.035, P < 0.001], a significantly higher number of patients with liver failure (23 vs 0, χ²=18.373, P < 0.001), and a significantly poorer prognosis (P < 0.001). Compared with the AHE-M group, the AHE-S group had significantly higher baseline anti-HEV-IgM, alpha-fetoprotein, and liver elasticity (Z=-3.534, -3.588, and -4.496, all P < 0.001), significantly lower baseline CD4 (Z=-2.015, P < 0.05), significantly higher peak values of TBil, direct bilirubin, creatinine, prothrombin time, international normalized ratio, and absolute neutrophil count (Z=-11.016, -10.926, -2.726, -4.787, -4.989, and -6.016, all P < 0.01), a significantly lower peak value of gamma-glutamyl transpeptidase (GGT) (Z=-4.55, P < 0.001), and significantly lower valley values of albumin, prealbumin (PA), and absolute lymphocyte count (Z=-4.685, -5.087, and -4.818, all P < 0.001). The logistic regression analysis showed that anti-HEV-IgM (odds ratio [OR]=1.022, 95% confidence interval [CI]: 1.005-1.039, P=0.012), GGT (OR=0.995, 95%CI: 0.993-0.998, P=0.001), PA (OR=0.991, 95%CI: 0.983-0.999, P=0.02), and neutrophils (OR=1.486, 95%CI: 1.169-1.889, P=0.001) were independent risk factors for severe jaundice in AHE patients. Conclusion There is a relatively high proportion of male patients among the AHE patients with severe jaundice, with a long length of hospital stay, a large number of patients with liver failure, and poor prognosis. Anti-HEV-IgM, GGT, PA, and neutrophils are independent risk factors for severe jaundice in AHE patients.
- Hepatitis E,
- Jaundice,
- Risk factors

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References

[1]	REIN DB, STEVENS GA, THEAKER J, et al. The global burden of hepatitis E virus genotypes 1 and 2 in 2005[J]. Hepatology, 2012, 55(4): 988-997. DOI: 10.1002/hep.25505
[2]	LOZANO R, NAGHAVI M, FOREMAN K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010[J]. Lancet, 2012, 380(9859): 2095-2128. DOI: 10.1016/S0140-6736(12)61728-0
[3]	World Health Organization. Hepatitis E: fact sheet[EB/OL].[2020-09-02]. https://www.who.int/en/news-room/fact-sheets/detail/hepatitis-e.
[4]	WEBB GW, DALTON HR. Hepatitis E: An underestimated emerging threat[J]. Ther Adv Infect Dis, 2019, 6: 2049936119837162. http://www.ncbi.nlm.nih.gov/pubmed/30984394
[5]	AGGARWAL R. Hepatitis E: Clinical presentation in disease-endemic areas and diagnosis[J]. Semin Liver Dis, 2013, 33(1): 30-40. DOI: 10.1055/s-0033-1338112
[6]	ABRAVANEL F, PIQUE J, COUTURIER E, et al. Acute hepatitis E in French patients and neurological manifestations[J]. J Infect, 2018, 77(3): 220-226. DOI: 10.1016/j.jinf.2018.06.007
[7]	LU F, LIU QN, WANG SM, et al. Clinical characteristics of hepatitis E[J]. Chin Hepatol, 2020, 25(7): 762-764. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZUAN202007032.htm 卢锋, 刘倩楠, 王寿明, 等. 戊型肝炎临床特征研究[J]. 肝脏, 2020, 25(7): 762-764. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUAN202007032.htm
[8]	Ministry of Health of the People's Republic of China. Diagnostic criteria for viral hepatitis E(WS-2008)[EB/OL].[2020-09-02]. http://www.nhc.gov.cn/wjw/s9491/200908/42097.shtml. (in Chinese) 中华人民共和国卫生部. 戊型病毒性肝炎诊断标准(WS-2008)[EB/OL]. [2020-09-02]. http://www.nhc.gov.cn/wjw/s9491/200908/42097.shtml.
[9]	Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.01.007 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007
[10]	XU B, YU HB, HUI W, et al. Clinical features and risk factors of acute hepatitis E with severe jaundice[J]. World J Gastroenterol, 2012, 18(48): 7279-7284. DOI: 10.3748/wjg.v18.i48.7279
[11]	KAMAR N, BENDALL R, LEGRAND-ABRAVANEL F, et al. Hepatitis E[J]. Lancet, 2012, 379(9835): 2477-2488. DOI: 10.1016/S0140-6736(11)61849-7
[12]	MANSUY JM, ABRAVANEL F, MIEDOUGE M, et al. Acute hepatitis E in south-west France over a 5-year period[J]. J Clin Virol, 2009, 44(1): 74-77. DOI: 10.1016/j.jcv.2008.09.010
[13]	DALTON HR, STABLEFORTH W, THURAIRAJAH P, et al. Autochthonous hepatitis E in Southwest England: Natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease[J]. Eur J Gastroenterol Hepatol, 2008, 20(8): 784-790. DOI: 10.1097/MEG.0b013e3282f5195a
[14]	BO QN, WANG SY, MA CH, et al. Epidemiological and clinical characteristics of senile hepatitis E in Qinhuangdao area[J]. Infect Dis Info, 2020, 33(3): 239-242. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-CRBX202003012.htm 卜秋宁, 王术艺, 马翠花, 等. 秦皇岛地区老年戊型肝炎流行病学及临床特征分析[J]. 传染病信息, 2020, 33(3): 239-242. https://www.cnki.com.cn/Article/CJFDTOTAL-CRBX202003012.htm
[15]	TARANTINO G, ORTOLANI A, MARINELLI K, et al. Locally acquired hepatitis E virus in Marche Italy: Clinical/laboratory features and outcome[J]. Dig Liver Dis, 2020, 52(4): 434-439. DOI: 10.1016/j.dld.2019.11.015
[16]	SATO N, WATANABE S, MIURA K, et al. Clinical and virologic features of hepatitis E virus infection at a university hospital in Japan between 2000 and 2019[J]. J Med Virol, 2020.[Online ahead of print]
[17]	WALLACE SJ, SWANN R, DONNELLY M, et al. Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: A multicentre retrospective study[J]. Aliment Pharmacol Ther, 2020, 51(10): 974-986. DOI: 10.1111/apt.15704
[18]	KILONZO SB, WANG YL, JIANG QQ, et al. Superinfective hepatitis E virus infection aggravates hepatocytes injury in chronic hepatitis B[J]. Curr Med Sci, 2019, 39(5): 719-726. DOI: 10.1007/s11596-019-2097-0
[19]	STEVE RJ, GNANADURAI FJ, ANANTHARAM R, et al. Expanded diagnostic approach to hepatitis E virus detection in patients with acute-on-chronic liver failure: A pilot study[J]. Indian J Med Microbiol, 2018, 36(3): 391-396. DOI: 10.4103/ijmm.IJMM_18_35
[20]	ZHU B, YOU SL, LIU HL, et al. Clinical analysis of 1489 patients with sporadic hepatitis E[J]. Chin J Virol, 2015, 5(3): 208-211. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZRYX201503011.htm 朱冰, 游绍莉, 刘鸿凌, 等. 1489例散发性戊型肝炎患者临床分析[J]. 中国病毒病杂志, 2015, 5(3): 208-211. https://www.cnki.com.cn/Article/CJFDTOTAL-ZRYX201503011.htm
[21]	LIAO BL, LIN SW, SHI HY, et al. Analysis of clinical characteristics of 334 patients with chronic hepatitis B overlapping infection with hepatitis E virus[J]. Chin J Hepatol, 2015, 23(9): 697-699. (in Chinese) 廖宝林, 林思炜, 施海燕, 等. 334例慢性乙型肝炎重叠感染戊型肝炎病毒患者临床特征分析[J]. 中华肝脏病杂志, 2015, 23(9): 697-699.
[22]	MIRAZO S, RAMOS N, MAINARDI V, et al. Transmission, diagnosis, and management of hepatitis E: An update[J]. Hepat Med, 2014, 6: 45-59. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051621/
[23]	ZHAO WM, PAN HD, DONG PL, et al. Clinical analysis of serum antibodies in 917 patients with sporadic acute hepatitis E[J]. Chin J Gastroenterol Hepatol, 2020, 29(1): 71-73. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX202001017.htm 赵文敏, 潘泓多, 董培玲, 等. 917例散发急性戊型肝炎患者血清抗体临床分析[J]. 胃肠病学和肝病学杂志, 2020, 29(1): 71-73. https://www.cnki.com.cn/Article/CJFDTOTAL-WCBX202001017.htm
[24]	LI XH, WANG JH, JI Y, et al. Value of hepatitis Evirus nucleic acid, antigen, and antibodies in the diagnosis of hepatitis E virus infection[J]. J Clin Hepatol, 2020, 36(1): 98-101. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.09.022 李晓鹤, 王江华, 季颖, 等. HEV核酸、抗原、抗体对HEV感染的诊断价值[J]. 临床肝胆病杂志, 2020, 36(1) : 98-101. DOI: 10.3969/j.issn.1001-5256.2020.09.022

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Clinical features and risk factors of acute hepatitis E with severe jaundice

DOI: 10.3969/j.issn.1001-5256.2021.03.013