Hepatitis E Virus Infection in Hyperbilirubinemia Patients Progressed to Liver Failure in 2003-2021, China

Hepatitis E virus (HEV)-related liver failure is increasingly reported. Patients with hyperbilirubinemia usually indicate liver damage and may develop liver failure, but HEV infection in them is less studied. This study aimed to investigate HEV infection in hyperbilirubinemia patients. A total of 949 patients with total bilirubin (Tbil) > 171 μmol/L during 2003-2021 in Beijing Youan hospital were tested for HEV. We found that 10.43% (99/949) patients were positive for anti-HEV IgM, or/and HEV pathogen markers. After ruling out 10 patients with incomplete data, 64.0% (57/89) progressed to liver failure. Patients with greater end-stage liver disease model scores tended to develop liver failure and have a poorer prognosis after HEV insult, evidenced by lower recovery/improvement rates. Liver cirrhosis patients with poorer Child-Turcotte-Pugh grades also tended to develop liver failure after HEV insult. In liver failure patients, those with HEV infection showed higher proportions of fatty liver and recent gastrointestinal haemorrhage than those without HEV infection. In conclusion, HEV infection is not uncommon in patients with Tbil > 171 μmol/L, and hyperbilirubinemia patients with more severe liver diseases are at more risk for liver failure after HEV infection.