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The incidence of fulminant hepatic failure in acute viral hepatitis in Taiwan: Increased risk in patients with pre-existing HBsAg carrier state

Inzidenz des fulminanten Leberversagens bei akuter Virushepatitis in Taiwan: Erhöhtes Risiko bei Patienten mit vorbestehendem HBsAg Carrierstatus

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Summary

The incidence of fulminant hepatitis in Taiwan was studied in a series of consecutive 523 patients with acute viral hepatitis including 11 with acute hepatitis A, 67 with acute hepatitis B, 124 with acute hepatitis NANB and 321 acute hepatitis in HBsAg carriers (patients who were HBsAg positive but anti-HBc IgM negative). Thirty-eight (7.3%) were recognized as fulminant hepatitis. The incidence of fulminant hepatitis was relatively low in patients with acute hepatitis A, B or NANB (2.0% or 4 out of 202), but was much higher in HBsAg carriers with acute hepatitis (10.6% or 34 out of 321). The incidence of fulminant hepatitis correlated significantly with the pre-existing HBsAg carrier state after adjustment of the confounding effect of age. The incidence of fulminant hepatitis in HBsAg carriers with acute hepatitis showed no significant difference in relation to sex or the presence of anti-delta in serum, but it increased proportionally with age. We concluded that the pre-existing HBsAg carrier state was a major risk factor for development of fulminant viral hepatitis. The etiology of superimposed acute hepatitis leading to fulminant hepatic failure might be varied according to the different geographic origins.

Zusammenfassung

Die Inzidenz der fulminanten Hepatitis in Taiwan wurde an 523 nacheinander eingewiesenen Fällen von akuter Virushepatitis bestimmt. Darunter waren 11 Fälle mit akuter Hepatitis A, 67 mit akuter Hepatitis B, 124 mit akuter Hepatitis NonA, NonB und 321 Fälle mit akuter Hepatitis bei HBsAg-Trägern (Patienten, die HBsAg-positiv, aber anti-HBc-IgM-negativ waren). Bei 38 Patienten (7,3%) wurde eine fulminante Hepatitis festgestellt. Bei Patienten mit akuter Hepatitis A, B oder NonA, NonB war die Inzidenz an fulminanter Hepatitis relativ gering (2% oder 4 von 202). Sehr viel häufiger fand sie sich bei HBsAg-Trägern mit akuter Hepatitis (10,6% oder 34 von 321). Nach Anpassung der Daten durch Ausschluß des Störfaktors Alter ergab sich eine signifikante Korrelation zwischen der Inzidenz der fulminanten Hepatitis und vorbestehendem HBsAg Carrierstatus. In bezug auf Geschlecht oder Anwesenheit von anti-delta im Serum fanden sich keine signifikanten Unterschiede in der Inzidenz der fulminanten Hepatitis bei HBsAg-Trägern mit akuter Hepatitis, doch nahm sie proportional mit dem Alter zu. Wir schließen aus den Daten, daß der vorbestehende HBsAg Carrierstatus ein entscheidender Risikofaktor für das Auftreten einer fulminanten Virushepatitis war. Es ist anzunehmen, daß die Ätiologie der aufgepfropften akuten Hepatitis, die zum fulminanten Leberversagen führt, nach geographischen Regionen unterschiedlich ist.

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  1. Liver Unit, Chang Gung Memorial Hospital and Chang Gung Medical College, 199, Tung Hwa North Road, 10591, Taipei, Taiwan

    C. -M. Chu M.D. & Y. -F. Liaw M.D.

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  1. C. -M. Chu M.D.
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  2. Y. -F. Liaw M.D.
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Chu, C.M., Liaw, Y.F. The incidence of fulminant hepatic failure in acute viral hepatitis in Taiwan: Increased risk in patients with pre-existing HBsAg carrier state. Infection 18, 200–203 (1990). https://doi.org/10.1007/BF01643385

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