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Purpose
Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA.
Materials and Methods
A total of 304 patients with HA admitted to our institution between...
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Hepatic encephalopathy (HE) represents a brain dysfunction caused by both acute and chronic liver failures, and its severity deeply affects the prognosis of patients with impaired liver function. In its pathophysiology, ammonia levels and glutamatergic system hyperactivity seem to play a pivotal role in the disruption of brain homeostasis. Here, we...
Acute liver failure is a rare presentation of hematologic malignancy. Acute on chronic liver failure (ACLF) is a newly recognized clinical entity that describes acute hepatic decompensation in persons with preexisting liver disease. Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin's lymphoma (NHL) with increasing incidence in olde...
Background
Between 2016-2018, San Diego County experienced a hepatitis A outbreak with a historically high mortality rate (3.4%) that highlighted the need for early recognition of those at risk of developing acute liver failure (ALF).
Methods
A retrospective case series of adult hospitalized patients with acute hepatitis A.
Results
106 patients w...
Background
Acute hepatic dysfunction in the critically ill population with pre-existing liver cirrhosis is associated with a high mortality. Several prediction models have been developed to risk stratify patients with liver disease.
Methods
This UK dual-centre non-specialist hospital retrospective study (2015–2019) externally validated the Liver i...
Acute liver failure (ALF) in infancy and childhood is a life-threatening emergency. Few conditions are known to cause recurrent acute liver failure (RALF), and in about 50% of cases, the underlying molecular cause remains unresolved. Exome sequencing in five unrelated individuals with fever-dependent RALF revealed biallelic mutations in NBAS. Subse...
Citations
... En effet, Takikawa et al. ont établi que l´âge avancé est un facteur de risque important pour prédire l´EH [7]. Ceci a été conforté par plusieurs autres études [6,8,9]. Dans notre série, l´âge moyen des patients ayant développé une EH était plus élevé sans différence significative (p=0,143). ...
... Concernant le rôle du genre, notre résultat concorde avec la littérature. En effet, plusieurs études n´ont pas retenu le sexe comme étant un facteur de risque de l´EH [6,9]. ...
... Contrairement à notre étude, l´alcoolisme était plus fréquemment retrouvé chez les patients n´ayant pas présenté une EH (p=0.039). Concernant le diabète, certaines études n´ont pas trouvé ce facteur comme prédictif de l´EH [8,10] , contrairement à l´étude de Hye Sun Shin et al. où le diabète était associé à l´apparition de l´IHA [9]. Dans notre étude, le diabète n´était pas un facteur prédictif de l´EH. ...
Introduction
l´atteinte hépatique aiguë sévère (AHAS) est une inflammation aiguë du foie avec des perturbations des marqueurs d´atteinte hépatique et des signes d´insuffisance hépatocellulaire (ictère et INR supérieur à 1,5) selon définition de l´association européenne pour l'étude du foie.Le facteur qui conditionne le pronostic de l´AHAS reste l´apparition d´une encéphalopathie hépatique (EH). L´objectif de ce travail est de rechercher les facteurs prédictifs du développement de l´EH au cours de l´AHAS.
Méthodes
il s´agit d´une étude observationnelle rétrospective entre janvier 2000 et décembre 2019. Nous avons réalisé une étude analytique comparant les deux groupes en fonction de l´apparition ou non d´une EH.
Résultats
cinquante-neuf patients ont été colligés. La survenue d'une EH était observée chez 15 patients (25,4%). Les facteurs prédictifs de la survenue d´une EH en analyse univariée étaient un délai de consultation supérieur à 9 jours, un taux d´INR supérieur à 2,45, un taux de bilirubine supérieur à 230 μmol/l, créatininémie supérieur à 60,5 μmol/l, un taux d'urée supérieur à 5,5 mmol/l et un score MELD supérieur à 26,5 (p=0,023, p = 0,017, p = 0,0001, p=0,049, p = 0,0001, p = 0,0001 respectivement). L´hépatite auto-immune et la cause indéterminée étaient associées à l´apparition d´une EH (respectivement p=0,003 et p=0,044). En analyse multivariée, l´étiologie auto-immune et un taux d´urée supérieur à 5,5 mmol/l étaient significativement associés à la survenue d´une EH.
Conclusion
la survenue de l´EH est le résultat de l´interférence de plusieurs facteurs associant des paramètres biologiques comme l´INR, la bilirubinémie, la fonction rénale et l´étiologie en cause.
... On the contrary, in developed countries with good sanitary conditions, the incidence of HA in adults can result more frequently in severe hepatitis. Fulminant and fatal HA can occur, particularly in older individuals [4][5][6][7][8][9] . ...
Hepatitis A virus (HAV) infection has been considered one of the leading causes of acute hepatitis. The aim of the present study was to estimate the prevalence of HAV among children and adolescents in a population-based study in the capitals of the States of the North, Southeast and South of Brazil and identify predictive factors for the infection. A multi-stage sampling was used to select subjects aged between 5-9 and 10-19 years. Individual and household levels aside from the level of variables in the areas were collected. The outcome was the total IgG antibodies to HAV levels detected using a commercial Enzyme Immuno Assay (EIA). The associations between HAV and the independent variables were assessed using the odds ratio. A multilevel analysis was performed by GLLAMM using the Stata software. The prevalence of HAV infection in the 5-9 and 10-19 age groups was 28.7% and 67.5%, respectively for the North, 20.6% and 37.7%, for the Southeast and 18.9% and 34.5% for the South Region. The prevalence of HAV increased according to age in all sites. Variables related to education at the individual level (North and South), family and area level (South and Southeast) and family income level (Southeast and South) were independently associated with HAV infection. This emphasizes the need for individualized strategies to prevent the infection.
KEYWORDS:
Hepatitis A infection; Risk factors; Brazil; Multilevel analysis
... Early identification of risk factors for ALF is desirable as this information would aid in the timely triage of these patients to higher level of care and possibly guide empiric therapies. To date, there are only a few reports that describe risk factors for the development of ALF in the setting of acute hepatitis A, and none of these studies involve patients from any of the recent US hepatitis A outbreaks [6][7][8]. The aim of this study was to identify patient characteristics-available at the time of initial presentation to a healthcare provider-that could be useful in predicting whether a patient with hepatitis A was at increased risk of developing ALF. ...
... In a case series of patients from Guatemala and Mexico, a serum albumin level of <2.5 mg/dL was associated with mortality which was consistent with our ROC best cutoff of <2.45 mg/dL for predicting ALF [11]. On the other hand, our study differed from prior studies which suggested that serum creatinine, advanced age, alcohol use disorder, and chronic hepatitis B infection portended increased ALF A c c e p t e d M a n u s c r i p t incidence in acute hepatitis A [8,11,16]. Each of these variables was evaluated and was not significantly associated with ALF in our study. ...
... patients with hepatitis C) [8,16]. Also, only one patient was infected with HIV. ...
Background
Between 2016-2018, San Diego County experienced a hepatitis A outbreak with a historically high mortality rate (3.4%) that highlighted the need for early recognition of those at risk of developing acute liver failure (ALF).
Methods
A retrospective case series of adult hospitalized patients with acute hepatitis A.
Results
106 patients with hepatitis A were studied of whom 11 (10.4%) developed ALF of whom 7 (6.6%) died. A history of alcohol abuse, hyperbilirubinemia, hypoalbuminemia, hyponatremia and anemia were associated with increased odds of developing ALF. Initial Maddrey’s and Model of End-Stage Liver Disease Sodium (MELD-Na) scores were also associated with the development of ALF. Multivariable analysis showed a higher initial MELD-Na score (OR 1.205; 95% CI 1.018-1.427) and a lower initial serum albumin concentration (OR 9.35 95% CI 1.15-76.9) were associated with increased odds of developing ALF. Combining serum albumin and MELD-Na (SAM) (C-statistic = 0.8878 [95% CI 0.756-.988]) yielded a model that was not better than either serum albumin (C-statistic = 0.852 (95% [CI 0.675-0.976]) or MELD-Na (C-statistic = 0.891 [95% CI 0.784-.968] (p=0.841). Finally, positive blood cultures were more common among patients with ALF compared to those without ALF (63.6% vs 4.3%, p<0.00001).
Conclusions
Hypoalbuminemia was associated with an increased risk of ALF in patients with acute hepatitis A. Positive blood cultures and septic shock as a cause of death were common among patients with ALF. Providers caring for patients with acute hepatitis A should monitor for early signs of sepsis and consider empiric antibiotics especially in patients presenting with hypoalbuminemia.
... The complement system activation occurs in viral liver diseases [31][32][33][34][35]. Despite preventive measures, some viral liver diseases are widespread in developing countries causing acute hepatitis and its worst outcome is acute liver failure [33,36]. ...
... The complement system activation occurs in viral liver diseases [31][32][33][34][35]. Despite preventive measures, some viral liver diseases are widespread in developing countries causing acute hepatitis and its worst outcome is acute liver failure [33,36]. Here, we confirmed the early impact of ALF plasma samples on HepG2 proliferation and viability, mimicking ALF liver environment. ...
The complement system plays an important role in innate immunity inducing liver diseases as well as signaling immune cell activation in local inflammation regulating immunomodulatory effects such as liver damage and/or liver regeneration. Our aim is to evaluate the role of complement components in acute liver failure (ALF) caused by viral hepatitis, involving virus-induced ALF in human subjects using peripheral blood, samples of liver tissues, and ex vivo assays. Our findings displayed low levels of C3a in plasma samples with high frequency of C3a, C5a, and C5b/9 deposition in liver parenchyma. Meanwhile, laboratory assays using HepG2 (hepatocyte cell line) showed susceptibility to plasma samples from ALF patients impairing in vitro cell proliferation and an increase in apoptotic events submitting plasma samples to heat inactivation. In summary, our data suggest that the complement system may be involved in liver dysfunction in viral-induced acute liver failure cases using ex vivo assays. In extension to our findings, we provide insights into future studies using animal models for viral-induced ALF, as well as other associated soluble components, which need further investigation.
... In acute liver failure, the presence of SIRS, whether or not precipitated by infection, has been implicated in the progression of HE, reducing the chances of transplantation and conferring a poorer prognosis [13]. Furthermore, higher SIRS scores are related to the development of acute liver failure in patients with pre-existing hepatitis [14]. ...
Primary hepatopathies are a common cause of morbidity and mortality in dogs. The underlying aetiology of most cases of canine hepatitis is unknown. Consequently, treatments are typically palliative and it is difficult to provide accurate prognostic information to owners. In human hepatology there is accumulating data which indicates that the presence of systemic inflammatory response syndrome (SIRS) is a common and debilitating event in patients with liver diseases. For example, the presence of SIRS has been linked to the development of complications such as hepatic encephalopathy (HE) and is associated with a poor clinical outcome in humans with liver diseases. In contrast, the relationship between SIRS and clinical outcome in dogs with a primary hepatitis is unknown. Seventy dogs with histologically confirmed primary hepatitis were enrolled into the study. Additional clinical and clinicopathological information including respiratory rate, heart rate, temperature, white blood cell count, sodium, potassium, sex, presence of ascites, HE score, alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin and red blood cell concentration were available in all cases. The median survival of dogs with a SIRS score of 0 or 1 (SIRS low) was 231 days compared to a median survival of 7 days for dogs with a SIRS score of 2, 3 or 4 (SIRS high) (p<0.001). A Cox proportional hazard model, which included all other co-variables, revealed that a SIRS high score was an independent predictor of a poor clinical outcome. The effect of modulating inflammation on treatment outcomes in dogs with a primary hepatitis is deserving of further study.
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.
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.
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.
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.
The global burden of deaths due to liver failure is substantial. The Asia‐Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. The etiology of liver failure varies in different countries at different times. Viruses (Hepatitis A, B and E), drugs (herbs and anti tuberculous drugs), toxins (alcohol use) and autoimmune flares are mainly responsible of majority of liver failure in individuals with normal liver (acute liver failure; ALF); else these may precipitate liver failure in those with chronic liver disease (acute‐on‐chronic liver failure; ACLF). Concomitant increases in alcohol misuse and metabolic syndrome in recent years is concerning. Ongoing efforts to address liver failure related morbidity and mortality require accurate contemporary estimates of epidemiology and outcomes. In light of the ever‐changing nature of liver disease epidemiology, accurate estimates for the burden of liver failure across the countries are vital for setting clinical, research, and policy priorities. In this review, we aimed to describe the current as well as changing epidemiological trends of common liver failure syndromes, ALF and ACLF in the Asia‐Pacific region.
Objectives
We analysed Hepatitis A (HepA) notifications and hospitalisations in Italy, Netherlands, Norway, Spain and Sweden for available periods between 1995 and 2014 to investigate whether decreasing HepA incidence is associated with increasing age at infection and worsening HepA presentation, and to identify groups-at-risk of severe disease.
Methods
We performed a retrospective cohort study including 36734 notified and 36849 hospitalised patients. We used negative binomial regressions to identify over time i) trends in hospitalisation and notification rates; ii) proportion of hospitalised and notified patients aged ≥40 years; iii) proportion of severe hospitalisations; and iv) risk factors for severe hospitalisation.
Results
During the study period: both HepA notifications and hospitalisations decreased, with notification rates decreasing faster; patients aged ≥40 years increased; however, the proportion of severe HepA hospitalisations remained stable. Older patients and patients with co-morbidities, particularly liver diseases, were more likely to experience severe disease.
Conclusions
We used digitalised health information to confirm decreasing trends in HepA hospitalisations and notifications, and an increasing age of HepA patients in Europe. We did not identify an increase in the severity of the clinical presentation of HepA patients. Older patients with liver diseases are at increased risk of severe disease and should be prioritised for vaccination.
BACKGROUND: Perioperative treatment of emergency liver transplantation for acute hepatic failure is extremely different from common liver transplantation, due to complex conditions, high risk, several complications, and high mortality. OBJECTIVE: To summarize the experience of emergency liver transplantation for acute hepatic failure during the perioperative period, and to increase the success rate in treatment of acute hepatic failure. METHODS: A retrospective analysis was undertaken on the clinical data of 38 cases undergone emergency liver transplantation for acute hepatic failure. There were 21 male and 17 female, who aged 15-69 years. Among them, 23 cases had hepatitis B virus (including 2 cases with hepatitis B and C virus), 7 cases had Wilsons disease, 3 cases had mushroom poisoning, 2 cases had unknown liver damage, 1 case had Tripterygium wilfordii poisoning, 1 case had decompensation after partial liver resection due to trauma, and 1 case had liver transplantation from corpse. RESULTS AND CONCLUSION: The survival time of the involve patients was 13-1 740 days, and the median survival time was 634 days. Perioperative survival rate was 76%, 1-year survival rate was 63%, and 2-year survival rate was 58%. During the perioperation nine cases died of brain edema and intracranial hypertension, renal failure, severe pulmonary infection, multiple organ failure, coagulation disorders (intracranial hemorrhage, upper digestive tract hemorrhage), acute respiratory distress syndrome and primary graft non-function. At present, emergency liver transplantation is still the most effective way for acute liver failure. Hemorrhage, infection and rejection are the leading causes of the death. Each perioperative treatment is of great significance for the success of liver transplantation and long-term survival. © 2014, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
