Clinical Features And Outcome Of Sporadic Hepatitis E Virus Infection In Shandong,China

Background and ObjectiveAcute hepatitis E(AHE)as the intestinal infectious disease caused by hepatitis E virus(HEV)is distributed globally.It is mainly distributed in developing countries in Asia and Africa,there are also sporadic cases occurring in developed countries.In the epidemic area,the mortality in pregnant women infected with HEV was 10%to 25%,patients with pre-existing chronic liver disease may easily develop severe hepatitis.AHE seriously harm human health which has become a global concern health problem.HEV is a single stranded RNA virus,and four genotypes have been found.In China the genotype 1(HEV-1)and genotype 4(HEV-4)are the most common genotypes.The first documented outbreak of HEV took place in India during 1955 and 1956 and involved 29.300 cases.Since then.large outbreaks involving thousands of affected individual have occurred subsequently in many countries including Mexico,Ethiopia,China,Vietnam,Sudan,Uganda,etc.In China,AHE is mainly associated with HEV-1 and the previous researches have focused on the clinical features and prognosis which is caused by this type.Nowadays,with the development of society and the improvement of health conditions,the cases caused by HEV-1 decreased,while the sporadic hepatitis E virus infection is growing rapidly in recent years and the recent studies have shown that sporadic hepatitis E in China is mainly caused by HEV-4,however,the clinical features and outcomes of sporadic hepatitis E were not well defined.The aim of our study was to investigate the clinical features and outcome of sporadic hepatitis E virus infection in Shandong province.Methods1.The hospitalized patients with AHE diagnosed in Jinan infectious disease hospital from January 2003 to December 2014 were investigated.The diagnostic criteria of AHE were based on "Diagnostic criteria for hepatitis E" which was issued by People's Republic of China Ministry of Health in 2008.The detection of anti-HEV IgM and/or anti-HEV IgG should be positive.Patients should have significant clinical symptoms,such as fever,fatigue,loss of appetite,jaundice and the biochemical results,such as alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)levels are abnormal.2.In this study,the clinical characteristics of AHE including demographics(e.g.gender,age,residence,etc.),symptoms and signs(e.g.fever,fatigue,loss of appetite,jaundice,etc.),biochemical markers(e.g.ALT,AST,TBIL,GGT,AKP,international normalized ratios,platelet count,etc.)and the risk factors of liver failure in patients with AHE were investigated.3.All data were input and analyzed by SPSS 16.0(SPSS 16.0,Inc.,Chicago,IL,USA),categorical variables were evaluated by using chi-square test,Kruskal-Wallis test or Mann-Whitney U test were used for numerical variables.Multivariate logistic regression analyses were used to identify the risk factors of liver failure happened in AHE Patients.The statistical tests were two-sided.P<0.05were defined as statistically significant.Results1.In our study,an obvious clustering of AHE cases was noted between February and March compared with other months.2.Among the 680 patients with sporadic hepatitis E,a large majority of the patients were male(574/680,84.4%).the mean age of the patients was 50.9 ± 12.8 years,the mean duration of hospitalization in the study was 29.6± 17.2days.HBsAg were detected in 126 cases(18.5%)and the HBsAg positive rate was significantly higher in AHE than in general population.3.Of the 680 cases.174 had fever(25.6%),mostpatients had other significant clinical symptoms,such as fatigue(582/680,85.6%),loss of appetite(570/680,83.8%).jaundice(631/680,92.8%),50 cases(7.4%)had ascites and 48 cases(7.1%)had hepatic encephalopathy.Patients with cholestasis,cirrhosis and liver failure were 57(8.4%),60(8.8%)and 102(15%),respectively.30 cases were dead,accounting for 4.4%in the study.Serum biochemical analysis of 680 patients showed that ALT.AST.TBIL,albumin(ALB),GGT,AKP,International normalized Ratios(INR),Platelet Count(PLT)median(minimum-maximum)were 727(8-6270)IU/L,300(17-6226)IU/L,196.8(8.0-1083)IU/L.33.0(15.2-45.8)g/L,160(10-3784)IU/L,154(47-2369)IU/L,1.15(0.81-41.9).162(10-589)× 109/L.4.Of the total 680 patients,102 cases(15%)developedliver failure(LF).Of the 102 LF patients,there were 24 cases(23.5%)with acute liver failure(ALF),28(27.5%)with Acute-on-Chronic Liver Failure(ACLF)and 50 cases(49%)with chronic liver failure(CLF).29 cases(28.4%)died.Compared with the patients without LF,the prevalence of smoking history,type 2 diabetes and HBsAg positivity were significantly higher(P<0.01);the prevalence of the clinical symptoms including fever,fatigue and jaundice were higher(P<0.001);the prevalence of ascites.hepatic encephalopathy,cirrhosis and the mortality were higher in patients with LF(P<0.001).LF patients had higher levels of TBIL and INR(P<0.001)and lower albumin levels and PLT(P<0.001).5.Adjusted for gender,Age>53 years,liver cirrhosis,type 2 diabetes mellitus and platelet<150×109/L,multivariate logistic regression showed that Age>53 years,liver cirrhosis and platelet<150×109/L were independently associated with occurrence of liver failure,with an odds ratio(95%confidence interval)1.6(1.1-2.7),2.9(1.5-5.6),3.7(2.3-6.0),respectively.Conclusions1.AHE was prevalent mainly in winter and spring,it was more common in middle-aged and old males,and the male-to-female ratio was was about 5:1.2.The positive rate of HBsAg in patients with hepatitis E was 18.5%,HBsAg positivity was associated with the occurrence of liver failure.3.The older age,liver cirrhosis and thrombocytopenia were independent risk factors of liver failure in AHE.