Archives of Virology

, Volume 159, Issue 8, pp 1901–1907

Determinants of poor outcome in patients with hepatitis A infection: a four-year retrospective study in Shiraz, Southern Iran

  • Kamran B. Lankarani
  • Mojtaba Mahmoodi
  • Behnam Honarvar
  • Parastoo Nematollahi
  • Nima Zamiri
  • Fariborz Ghaffarpasand
Original Article

DOI: 10.1007/s00705-014-2017-3

Cite this article as:
Lankarani, K.B., Mahmoodi, M., Honarvar, B. et al. Arch Virol (2014) 159: 1901. doi:10.1007/s00705-014-2017-3

Abstract

There are 1.4 million estimated cases of hepatitis A every year worldwide. We aimed to detect the correlates of poor outcome in patients with hepatitis A virus (HAV) infection. In this four-year retrospective study, which was conducted in Shiraz, Southern Iran, data of all hospitalized HAV patients were analyzed by SPSS and STATA. Out of 110 HAV patients, 8 (7.3 %) developed hepatic encephalopathy, and 7 (6.4 %) died. The results show that 19 years of age is a cutoff level for predicting mortality, with a sensitivity of 42.9 % and specificity of 91.3 %, and with an area under the curve (AUC) of 0.595 (95 % CI, 0.309–0.881). Every one-year increase in age adds 3 % to the mortality rate from severe hepatitis A. The cutoff level of alanine aminotransferase (ALT) for predicting death is 1819.5 IU/L, with a sensitivity of 100 %, specificity of 68 %, and AUC 0.877 (95 % CI, 0.777–0.977). Every 100 IU/L increase in ALT is associated with a 0.1 % increase in the risk of death. Patients from large families (OR, 0.583, 95 % CI, 0.46–0.74) and those who are not the firstborn child of their family (OR, 0.287, 95 % CI, 0.146–0.564) have better outcome. Adult patients with hepatitis A who are first children, are from a small family, or have a very high level of ALT are more prone to a poor outcome of this infection. Public education and establishment of a national surveillance system for HAV and an HAV vaccination program for high-risk populations should be regarded among the priorities of the health system of Iran.

Abbreviations

HAV

Hepatitis A virus

ALF

Acute liver failure

WHO

World Health Organization

ICD-10

International Classification of Disease Version 10

ICU

Intensive care unit

SPSS

Statistical Package for the Social Sciences

SD

Standard deviation

ROC

Receiver operating characteristics

AUC

Area under the curve

ALF

Acute liver failure

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Kamran B. Lankarani
    • 1
  • Mojtaba Mahmoodi
    • 1
  • Behnam Honarvar
    • 1
  • Parastoo Nematollahi
    • 1
    • 2
  • Nima Zamiri
    • 1
  • Fariborz Ghaffarpasand
    • 1
  1. 1.Community and Preventive Medicine, Health Policy Research CentreShiraz University of Medical Sciences, School of MedicineShirazIran
  2. 2.Student Research CommitteeShiraz University of Medical SciencesShirazIran