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Viral hepatitis-related acute liver failure
Frank Vinholt Schiødt1, Timothy J Davern, A Obaid Shakil
1Department of Gastroenterology, Rigshospitalet, Copenhagen, Denmark.
The American Journal of Gastroenterology
|February 20, 2003
Summary
Hepatitis A patients had a higher spontaneous survival rate (69%) compared to Hepatitis B patients (19%) in acute liver failure cases. This difference in outcomes for viral hepatitis is not explained by initial disease severity.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Viral hepatitis was historically the leading cause of acute liver failure (ALF) in the U.S.
- Current incidence and comparative outcomes of hepatitis A and B related ALF require updated investigation.
Purpose of the Study:
- To determine the incidence of viral hepatitis-related ALF in the U.S.
- To compare clinical and biochemical variables and outcomes between patients with hepatitis A and hepatitis B causing ALF.
Main Methods:
- Screening of 354 patients with ALF from multiple centers for acute viral etiology.
- Comparison of clinical, biochemical, and outcome data between hepatitis A and hepatitis B groups.
Main Results:
- Acute viral hepatitis accounted for 12.1% of ALF cases (43 patients: 16 hepatitis A, 26 hepatitis B, 1 HSV).
- Hepatitis A patients showed significantly higher platelet counts and a higher transplantation-free survival rate (69%) versus hepatitis B patients (19%).
- Hepatitis B patients had a higher liver transplantation rate (62%) compared to hepatitis A patients (19%).
Conclusions:
- Viral hepatitis now represents a smaller fraction (one-eighth) of ALF cases in the U.S.
- The disparity in spontaneous survival between hepatitis A and B is not attributable to initial hepatic dysfunction severity.
- Inherent infection characteristics or transplant selection bias may explain the survival difference.