DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20191674

Etiology and outcome of patients with viral-induced acute liver failure

Tauseef Nabi, Nadeema Rafiq

Abstract


Background: Acute liver failure (ALF) is a rare medical emergency and devastating clinical syndrome associated with high mortality in the absence of immediate intensive supportive care, specific treatment, or liver transplantation. Viral hepatitis is still one of the main causes of ALF in the India as well in world. We aimed to determine the etiology of Viral-ALF and to compare the outcome and clinical and biochemical variables in patients with hepatitis E and non HEV group in this prospective study.

Methods: A total of 37 patients with a diagnosis of viral-ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters, severity of liver injury, outcome, complications and duration of hospital stay.

Results: Out of 37 Viral-ALF patients, Acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). There were significantly more females in HEV group (61.1%) than non HEV group (21.1%) (P = 0.014). Overall mortality was 20 (54.1%). Mortality was higher in non HEV group (73.7%) than HEV group (33.3%) (P = 0.015). The mean age in HEV group was 30±12.7 years and in non HEV group was 38.1±10.4 years (P = 0.042). Bilirubin, ALT, mean grade of coma and interval between jaundice and encephalopathy were significantly higher in non HEV group than HEV group. MELD Score was higher in non HEV group 32.6±7.9 than HEV group 26.3±7.2 (P = 0.012). Sepsis and renal failure occurred more frequently in non HEV group than HEV group. Duration of hospital stay was also significantly more in non HEV group 11.3±3.3 days versus HEV group was 7.9 ± 2.9 (P = 0.002).

Conclusions: HEV was the most frequently associated with Viral-ALF. HEV related ALF disproportionately affected young women. Mortality was higher in non HEV group (73.7%) than HEV group (33.3%). The marked difference in spontaneous survival between HEV and non HEV group can be explained by the severity of hepatic dysfunction on admission and more frequent complications.


Keywords


Acute liver failure, Hepatic encephalopathy, Hepatitis E virus, Viral-ALF

Full Text:

PDF

References


Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis. 1970;3:282-98.

Hoofnagle JH, Carithers RL Jr, Shapiro C, Ascher N. Fulminant hepatic failure: summary of a workshop. Hepatol. 1995;21(1):240-52.

Bower WA, Johns M, Margolis HS, Williams IT, Bell BP. Population-based surveillance for acute liver failure. Am J Gastroenterol. 2007;102:2459-63.

Rockville. Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation; 2007.

Lee WM, Squires Jr RH, Nyberg SL, Doo E, Hoofnagle JH. Acute liver failure: summary of a workshop. Hepatol. 2008;47(4):1401-15.

Atterbury CE, Maddrey WC, Conn HO. Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy: a controlled, double-blind clinical trial. Am J Dig Dis. 1978;23(5):398-406.

Ostapowicz G, Fontana R J, Schiodt F V. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137:947-54.

Lee WM. Etiologies of acute liver failure. Semin Liver Dis. 2008;28(2):142-52.

Sugawara K, Nakayama N, Mochida S. Acute liver failure in Japan: definition, classification, and prediction of the outcome. J Gastroenterol. 2012;47(8):849-61.

Acharya SK, Dasarathy S, Kumer TL, Sushma S, Prasanna KS, Tandon A, et al. Fulminant hepatitis in tropical population: clinical course, cause, and early predictors of outcome. Hepatol. 1996;23:1448-55.

Tibbs C, Williams R. Viral causes and management of acute liver failure. J Hepatol. 1995;22(Suppl.1):68-73.

Fagan EA, Williams R. Fulminant viral hepatitis. Br Med Bull. 1990;46:462-80.

Khuroo MS, Kamili S. Aetiology and prognostic factors in acute liver failure in India. J Viral Hepat. 2003;10:224-31.

Khuroo MS, Teli MR, Skidmore S, Sofi MA, Khuroo MI. Incidence and severity of viral hepatitis in pregnancy. Am J Med. 1981;70:252-5.

Yoshiba M, Dehara K, Inoue K, Okamoto H, Mayumi M. Contribution of hepatitis C virus to non-A, non-B fulminant hepatitis in Japan. Hepatol. 1994;19:829-35.

Farci P, Alter HJ, Shimoda A, Govindarajan S, Cheung LC, Melpolder JC, et al. Hepatitis C virus-associated fulminant hepatic failure. N Engl J Med. 1996;335:631-4.

Govindarajan S, Chin KP, Redeker AG, Peters RL. Fulminant B viral hepatitis: Role of delta agent. Gastroenterol. 1984;86:1417-20.

Peters DJ, Greene WH, Ruggiero F, McGarrity TJ. Herpes simplex-induced fulminant hepatitis in adults. Dig Dis Sci. 2000;45(12):2399-404.

Farr RW, Short S, Weissman D. Fulminant hepatitis during herpes simplex virus infection in apparently immunocompetent adults: Report of two cases and review of the literature. Clin Infect Dis. 1997;24:1191-4.

Mellinger JL, Rossaro L, Naugler WE, Nadig SN, Appelman H, Lee WM, et al. Epstein–Barr virus (EBV) related acute liver failure: a case series from the US Acute Liver Failure Study Group. Dig Dis Sci. 2014;59(7):1630-7.

Srivastava P. Acute liver failure: due to Epstein Barr virus infection-a case report. J Hep. 2015;2:1.

Lee WM. Acute liver failure in the United States. Semin Liver Dis. 2003;23:217-26.

Schiodt FV, Atillasoy E, Shakil AO, Schiff ER, Caldwell C, Kowdley KV. Etiology and outcome for 295 patients with acute liver failure in the United States. Liver Transpl Surg. 1999;5(1):29-34.

Polson J, Lee WM. American Association for the Study of Liver Disease. AASLD position paper: the management of acute liver failure. Hepatol. 2005;41:1179-97.

Nabi T, Nabi S, Rafiq N, Shah A. Role of N-acetylcysteine treatment in non-acetaminophen-induced acute liver failure: A prospective study. Saudi J Gastroenterol. 2017;23(3):169-75.

Chughlay MF, Kramer N, Spearman CW, Werfalli M, Cohen K. N‐acetylcysteine for non‐paracetamol drug‐induced liver injury: a systematic review. Br J Clin Pharmacol. 2016;81(6):1021-9.

Darweesh SK, Ibrahim MF, El-Tahawy MA. Effect of N-Acetylcysteine on mortality and liver transplantation rate in non-acetaminophen-induced acute liver failure: a multicenter study. Clin Drug Investig. 2017;37(5):473-82.

Lee WM, Larson AM, Stravitz RT. AASLD Position paper: the management of acute liver failure: update, 2011. Available at: http://www. aasld.org/practiceguidelines/ Documents/AcuteLiverFailureUpdate2011.pdf. Accessed on January 2019.

European Association for the study of the liver. EASL clinical practical guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66(5):1047-81.

Lee WM, Sorrell MF. Developing a world view toward acute liver failure. Hepatol. 1996;24:270-1.

Khuroo MS, Duermeyer W, Zargar SA, Ahanger MA, Shah MA. Acute sporadic hepatitis in India. Am J Epidemiol. 1983;118:360-4.

Ramalingaswami V, Purcell RH. Waterborne Non-A, non-B hepatitis. Lancet. 1988;1:571-3.

Dalton HR, Bendall R, Ijaz S, Banks M. Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis. 2008;8(11):698-709.

Das AK, Begum T, Kar P, Dutta A. Profile of Acute liver failure from North-east India and its differences from other parts of country. Euro J Hepato-Gastroenterol. 2016;6(2):111-5.

Takahashi Y, Shimizu M. Aetiology and prognosis of fulminant viral hepatitis in Japan: a multicentric study. J Gastroenterol Hepatol. 1991;6:159-64.

Bianco E, Stroffolini T, Spada E, Szklo A, Marzolini F, Ragni P, et al. Case fatality rate of acute viral hepatitis in Italy: 1995-2000. An update. Dig Liver Dis. 2003;35(6):404-8.