Deteriorated outcome of recent patients with acute liver failure and late‐onset hepatic failure caused by infection with hepatitis A virus: A subanalysis of patients seen between 1998 and 2015 and enrolled in nationwide surveys in Japan. Issue 8 (29th May 2019)

• Record Type: Journal Article
• Authors: Nakao, Masamitsu; Nakayama, Nobuaki; Uchida, Yoshihito; Tomiya, Tomoaki; Oketani, Makoto; Ido, Akio; Tsubouchi, Hirohito; Takikawa, Hajime; Mochida, Satoshi
• Is Part Of: Hepatology research. Volume 49:Issue 8(2019)
• Page Start: 844
• Page End: 852
• Publication Date: 2019-05-29
• Subjects: acute liver failure -- aging -- diabetic mellitus -- fulminant hepatitis -- HAV -- LOHF; Liver -- Diseases -- Periodicals; Liver Diseases -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1111/hepr.13345
• Languages: English
• ISSNs: 1386-6346

Abstract

Abstract : Aim: A nationwide survey of acute liver failure (ALF) and late‐onset hepatic failure (LOHF) has revealed that the outcomes of recent patients whose diseases were caused by infection with hepatitis A virus (HAV) have worsened, compared with those of previously reported patients. The factors associated with this deterioration were evaluated. Methods: A total of 83 patients with HAV infection seen between 1998 and 2015 were enrolled. All the patients had a prothrombin time–international normalized ratio of 1.5 or more and hepatic encephalopathy of grade 2 or more severe. The demographic and clinical features of 45 patients seen prior to 2003 (cohort 1) and 38 patients seen during 2004 and thereafter (cohort 2) were compared. Results: Three and four patients in cohort 1 and cohort 2, respectively, received liver transplantations; the survival rates among the remaining patients were 56% for cohort 2 and 79% for cohort 1 ( P < 0.05). The mean age (±standard deviation) of the patients was higher in cohort 2 than in cohort 1 (58 ± 11 vs. 48 ± 13 years; P < 0.01). The percentages of patients with underlying metabolic diseases were 22% in cohort 1 and 61% in cohort 2 ( P < 0.01). Diabetic mellitus was more common among deceased patients than among rescued patients (29% vs. 8%; P < 0.05) among patients who did not receive liver transplantations, and a multivariate analysis revealed that patient age and disease type were significantly and independently associated with the outcome. Conclusion: The outcomes of recent patients with ALF or LOHF caused by HAV infection have recently worsened mainly because of an increase in underlying metabolic diseases as a consequence of aging.