Skip to main content

Advertisement

SpringerLink
Log in

Acute Liver Failure Due to Hepatitis E Virus Infection Is Associated with Better Survival than Other Etiologies in Indian Patients

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aim

Hepatitis E virus (HEV) is a global disease and an important cause of acute liver failure (ALF) in the Indian subcontinent. The aim of this study was to assess the differences in the course of HEV-ALF as compared to other etiologies of ALF.

Methods

We compared the clinical course, complications, and outcomes of HEV-ALF with other etiologies. We assessed the prognostic factors and compared existing prognostic scores in HEV-ALF patients.

Results

One thousand four hundred and sixty-two ALF patients were evaluated between January 1986 and December 2015. HEV was the etiology of ALF in 419 (28.7%) cases, whereas non-A non-E hepatitis, HBV and anti-tuberculosis therapy (ATT) were the etiologies in 527 (36.0%), 128 (8.8%), and 103 (7.0%) cases, respectively. The frequency of cerebral edema in HEV-ALF (41.3%) was lower than that in non-A non-E ALF (52.9%; P < 0.001) and HBV-ALF (52.8%; P = 0.024). Infection and seizures were significantly less in patients with HEV-ALF compared to non-A non-E and HBV-ALF (P = 0.038 and 0.022, respectively). The survival of HEV-ALF patients was significantly better (55.1%, P < 0.001) than patients of other etiologies—including ATT (30.0%), non-A non-E (38.1%) and HBV (35.9%). In HEV-ALF patients, age, female sex, cerebral edema, prothrombin time >60 s, infection, and total bilirubin were observed as independent predictors of outcome on multivariate logistic regression analysis. Model for end-stage liver disease, acute liver failure study group model and King’s College Hospital criteria had poor discriminative accuracy for outcome (area under receiver operator characteristic curve 0.63–0.64) in HEV-ALF.

Conclusions

Hepatitis E virus-associated ALF has a better outcome than ALF of other etiologies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ALF:

Acute liver failure

ALFED:

Acute liver failure early dynamic

ATT:

Anti-tuberculosis therapy

HAV:

Hepatitis A virus

HBV:

Hepatitis B virus

HEV:

Hepatitis E virus

INR:

International normalized ratio

KCH:

King’s College Hospital criteria

LT:

Liver transplant

MELD:

Model for end-stage liver disease

References

  1. Kumar R, Shalimar, Bhatia V, et al. Antituberculosis therapy-induced acute liver failure: magnitude, profile, prognosis, and predictors of outcome. Hepatology. 2010;51:1665–1674.

    Article  CAS  PubMed  Google Scholar 

  2. Acharya SK, Dasarathy S, Kumer TL, et al. Fulminant hepatitis in a tropical population: clinical course, cause, and early predictors of outcome. Hepatology. 1996;23:1448–1455.

    Article  CAS  PubMed  Google Scholar 

  3. Shalimar, Acharya SK, William ML. Worldwide differences in acute liver failure. In: Critical care in acute liver failure. Future Medicine Ltd; 2013 [cited 2016 May 14]. pp 32–46. http://www.futuremedicine.com/doi/abs/10.2217/ebo.12.326

  4. Lee WM. Acute liver failure. Semin Respir Crit Care Med. 2012;33:36–45.

    Article  PubMed  Google Scholar 

  5. Acharya SK, Panda SK. Hepatitis E: water, water everywhere—now a global disease. J Hepatol. 2011;54:9–11.

    Article  PubMed  Google Scholar 

  6. Fontana RJ, Engle RE, Scaglione S, et al. The role of hepatitis E virus infection in adult Americans with acute liver failure. Hepatology. 2016;64:1870–1880.

    Article  CAS  PubMed  Google Scholar 

  7. Manka P, Bechmann LP, Coombes JD, et al. Hepatitis E virus infection as a possible cause of acute liver failure in Europe. Clin Gastroenterol Hepatol. 2015;13:1836–1842.

    Article  PubMed  Google Scholar 

  8. Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55:988–997.

    Article  PubMed  Google Scholar 

  9. Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388:1081–1088.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Khuroo MS, Kamili S. Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy. J Viral Hepat. 2003;10:61–69.

    Article  CAS  PubMed  Google Scholar 

  11. Reuben A, Tillman H, Fontana RJ, et al. Outcomes in adults with acute liver failure between 1998 and 2013: an observational cohort study. Ann Intern Med. 2016;164:724–732.

    Article  PubMed  Google Scholar 

  12. Riegler JL, Lake JR. Fulminant hepatic failure. Med Clin North Am. 1993;77:1057–1083.

    Article  CAS  PubMed  Google Scholar 

  13. O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–445.

    Article  PubMed  Google Scholar 

  14. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–871.

    Article  CAS  PubMed  Google Scholar 

  15. Koch DG, Tillman H, Durkalski V, Lee WM, Reuben A. Development of a model to predict transplant-free survival of patients with acute liver failure. Clin Gastroenterol Hepatol. 2016;14:1199.e2–1206.e2.

    Article  Google Scholar 

  16. Kumar R, Shalimar Sharma H, Goyal R, Kumar A, Khanal S, et al. Prospective derivation and validation of early dynamic model for predicting outcome in patients with acute liver failure. Gut. 2012;61:1068–1075.

    Article  PubMed  Google Scholar 

  17. Nanda SK, Yalcinkaya K, Panigrahi AK, Acharya SK, Jameel S, Panda SK. Etiological role of hepatitis E virus in sporadic fulminant hepatitis. J Med Virol. 1994;42:133–137.

    Article  CAS  PubMed  Google Scholar 

  18. Jameel S, Durgapal H, Habibullah CM, Khuroo MS, Panda SK. Enteric non-A, non-B hepatitis: epidemics, animal transmission, and hepatitis E virus detection by the polymerase chain reaction. J Med Virol. 1992;37:263–270.

    Article  CAS  PubMed  Google Scholar 

  19. Khuroo MS, Teli MR, Skidmore S, Sofi MA, Khuroo MI. Incidence and severity of viral hepatitis in pregnancy. Am J Med. 1981;70:252–255.

    Article  CAS  PubMed  Google Scholar 

  20. Rab MA, Bile MK, Mubarik MM, et al. Water-borne hepatitis E virus epidemic in Islamabad, Pakistan: a common source outbreak traced to the malfunction of a modern water treatment plant. Am J Trop Med Hyg. 1997;57:151–157.

    CAS  PubMed  Google Scholar 

  21. Bhatia V, Singhal A, Panda SK, Acharya SK. A 20-year single-center experience with acute liver failure during pregnancy: is the prognosis really worse? Hepatology. 2008;48:1577–1585.

    Article  PubMed  Google Scholar 

  22. Shalimar, Acharya SK. Hepatitis e and acute liver failure in pregnancy. J Clin Exp Hepatol. 2013;3:213–224.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Aggarwal R. Hepatitis E: epidemiology and natural history. J Clin Exp Hepatol. 2013;3:125–133.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shalimar, Kumar D, Vadiraja PK, et al. Acute on chronic liver failure because of acute hepatic insults: etiologies, course, extrahepatic organ failure and predictors of mortality. J Gastroenterol Hepatol. 2016;31:856–864.

    Article  CAS  PubMed  Google Scholar 

  25. Shalimar, Saraswat V, Singh S, et al. Acute on chronic liver failure in India: the INASL Consortium experience. J Gastroenterol Hepatol. 2016;31:1742–1749.

    Article  Google Scholar 

  26. Nair VP, Anang S, Subramani C, et al. Endoplasmic reticulum stress induced synthesis of a novel viral factor mediates efficient replication of genotype-1 hepatitis E virus. PLoS Pathog. 2016;12:e1005521.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Aggarwal R, Naik S. Epidemiology of hepatitis E: current status. J Gastroenterol Hepatol. 2009;24:1484–1493.

    Article  PubMed  Google Scholar 

  28. Viral Hepatitis Surveillance—India, 2011–2013. [cited 2016 Jun 10]. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6428a3.htm?s_cid=mm6428a3_w

  29. Speiser JL, Lee WM, Karvellas CJ, US Acute Liver Failure Study Group. Predicting outcome on admission and post-admission for acetaminophen-induced acute liver failure using classification and regression tree models. PloS One. 2015;10:e0122929.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jaiswal SP, Jain AK, Naik G, Soni N, Chitnis DS. Viral hepatitis during pregnancy. Int J Gynaecol Obstet. 2001;72:103–108.

    Article  CAS  PubMed  Google Scholar 

  31. Beniwal M, Kumar A, Kar P, Jilani N, Sharma JB. Prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy: a prospective study from north India. Indian J Med Microbiol. 2003;21:184–185.

    CAS  PubMed  Google Scholar 

  32. Bernal W, Hyyrylainen A, Gera A, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J Hepatol. 2013;59:74–80.

    Article  PubMed  Google Scholar 

  33. Louvet A, Labreuche J, Artru F, et al. Combining data from liver disease scoring systems better predicts outcomes of patients with alcoholic hepatitis. Gastroenterology. 2015;149:398.e8–406.e8.

    Article  Google Scholar 

  34. McPhail MJW, Wendon JA, Bernal W. Meta-analysis of performance of Kings’s College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure. J Hepatol. 2010;53:492–499.

    Article  PubMed  Google Scholar 

Download references

Author's contributions

Shalimar, acquisition of data, study design and concept, data analysis, interpretation of data, drafting of manuscript; SK, acquisition of data; DG, acquisition of data; US, acquisition of data; SJM, acquisition of data; BN, acquisition of data; HK, acquisition of data; SKA, study design and concept, interpretation of data, critical revision of manuscript for important intellectual content.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India

    Shalimar, Saurabh Kedia, Deepak Gunjan, Ujjwal Sonika, Soumya Jagannath Mahapatra, Baibaswata Nayak, Harpreet Kaur & Subrat Kumar Acharya

Authors
  1. Shalimar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Saurabh Kedia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deepak Gunjan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ujjwal Sonika
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Soumya Jagannath Mahapatra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Baibaswata Nayak
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harpreet Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Subrat Kumar Acharya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Subrat Kumar Acharya.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shalimar, Kedia, S., Gunjan, D. et al. Acute Liver Failure Due to Hepatitis E Virus Infection Is Associated with Better Survival than Other Etiologies in Indian Patients. Dig Dis Sci 62, 1058–1066 (2017). https://doi.org/10.1007/s10620-017-4461-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4461-x

Keywords

Search

Navigation