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Determinants, profile and outcomes of hepatitis A virus–associated severe acute liver injury in adults

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Abstract

Background and Objectives

Hepatitis A virus (HAV)-related hepatitis is witnessing an epidemiological transition with increasing trends in adults. While uncomplicated hepatitis remains common, evidence suggests it to be a growing cause for acute liver failure (ALF). In between the two extremes exists severe acute liver injury (s-ALI) which has a propensity to transition to ALF. We aimed at describing the clinical profile of patients with HAV-related s-ALI and identifying potential predictors of progression to ALF.

Methods

This was a single-center retrospective analysis of adult patients admitted with HAV-related s-ALI between April 2022 and December 2023. Demographic and laboratory parameters were compared between patients with only s-ALI and those with ALF. Predictors of progression from s-ALI to ALF were identified using logistic regression.

Results

Forty-three patients satisfied criteria of s-ALI, of which 33 (76.7%) had only s-ALI, while 10 (23.3%) had ALF. Patients with s-ALI had lesser leukocytosis (6.3 ± 3 vs. 13.2 ± 4.8), less incidence of acute kidney injury (9.1% vs. 40%) and lower model for end-stage liver disease (MELD) (20 [18–24.5] vs. 31.5 [26–42]), arterial lactate (2.1 [1.3–3.1] vs. 6.3 [5.2–8.0]), arterial ammonia (94 [72–118] vs. 299 [188–573]), procalcitonin (0.5 [0.28–1.25] vs. 3.2 [1.2–6.1]) and ferritin (482 [213–1633] vs. 5186 [1341–11,053]) compared to HAV-ALF (p < 0.05 for all). Three patients (9.09%) with s-ALI progressed to ALF of whom one (3%) died. Baseline ammonia levels (unadjusted odds ratio [OR] 1.03 [1.01–1.06]) and leukocyte count (OR 1.00 [1.00–1.01]) tended to be associated with ALF progression, although none was significant after multi-variable adjustment. Ammonia levels had an area under receiver operating curve of 0.816 (0.64–0.93) (p = 0.009) (cut-off of 144 μmol/L). Additional comorbidities did not impact overall outcomes.

Conclusion

HAV presents as s-ALI in young adults, with almost one in 10 progressing to ALF. Baseline ammonia may be an important predictor of progression even in s-ALI, but mandates larger well-designed studies.

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Authors and Affiliations

  1. Department of Gastroenterology, Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, 700 054, India

    Akash Roy, Uday Chand Ghoshal, Kautuk Lohia, Indrajeet Tiwary, Subhash Tiwari, Awanish Tewari, Nikhil Sonthalia & Mahesh K. Goenka

  2. Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India

    Anand V. Kulkarni

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  1. Akash Roy
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  2. Uday Chand Ghoshal
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Contributions

AR: conceptualization (lead); writing—original draft, formal analysis (writing—review and editing). UCG: writing—original draft (supporting); writing—review and editing. AVK: conceptualization (supporting). KL: resources and project administration. IT: resources and project administration. CT: resources and project administration. NS: resources. AT: resources, review and editing.

Corresponding author

Correspondence to Mahesh K. Goenka.

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Conflict of interest

AR, UCG, AVK, KL, IT, ST, AT, NS and MKG  declare no competing interests.

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The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Ethical waiver was sought in view of retrospective case record analysis.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Roy, A., Ghoshal, U.C., Kulkarni, A.V. et al. Determinants, profile and outcomes of hepatitis A virus–associated severe acute liver injury in adults. Indian J Gastroenterol (2024). https://doi.org/10.1007/s12664-024-01577-3

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