A Study of Disseminated Intravascular Coagulopathy in Hepatic Coma Complicating Acute Viral Hepatitis

Singh, Ram Raj; Singh, Mahipal; Hazra, D. K.; Agarwal, Neha; Patney, N. L.; Goyal, Sunita; Bansal, Ojas; Mehrotra, Meenal; Sharma, Sushma

doi:10.1177/000331978303400707

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…However the most remarkable feature of FHF caused by HEV in pregnant women was the occurrence of DIC in 10 (22.2%) of 45 patients. Singh et al studied coagulation factors in 30 patients with acute viral hepatitis with or without hepatic encephalopathy from Agra, India [33]. DIC with significant clinical bleeding was seen in 10 of 15 patients with FHF.…”

Section: Discussionmentioning

confidence: 99%

Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy*

Khuroo

Kamili²

2003

Journal of Viral Hepatitis

283

208

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Hepatitis E causes large-scale epidemics in endemic areas. The disease, during epidemics, has increased incidence and severity in pregnant women. Sporadic acute viral hepatitis (AVH) is common in endemic areas. The relationship of sporadic AVH and pregnancy has not been well studied. Over a 3-year period we prospectively studied 76 pregnant women and 337 non-pregnant women of childbearing age with sporadic acute viral hepatitis for aetiology, clinical course and outcome of disease. The aetiology in sporadic AVH was hepatitis A virus (HAV) in six (1.5%), hepatitis B virus (HBV) in 62 (15%), hepatitis C virus (HCV) in seven (1.7%), hepatitis D virus (HDV) co-infection in six (1.5%), hepatitis E virus (HEV) in 205 (49.6%), and hepatitis non-A-to-E (HNAE) in 127 (30.7%). Sixty-five (85.5%) pregnant women and 140 (41.5%) nonpregnant women had hepatitis E. The proportion of pregnant women was 31.7% in HEV group and 5.3% in non-HEV group [P < 0.001; OR=8.3 (95%C1 4.2-16.3)]. The prevalence of HEV in pregnant women in first trimester (76.9%), second trimester (88.9%), third trimester (83.8%) and puerperium (100%) did not differ significantly (P=0.09). Forty-seven (61.8%) of the 76 pregnant women developed fulminant hepatic failure (FHF), 69.2% in HEV group and 10% in non-HEV group (P < 0.001). Thirty-four (10.1%) nonpregnant women developed fulminant hepatic failure, 10% in HEV group and 9.7% in non-HEV group (P=0.86). FHF had occurred in four (40%) of 10 patients with HE in first trimester as against 41 (74.5%) of 55 patients in second trimester and beyond (P=0.015). Amongst the major complications of fulminant hepatic failure, cerebral oedema (53.2%) and disseminated intravascular coagulation (21.3%) occurred more often in pregnant women than in nonpregnant women (29.4% and 2.8%; P=0.03 and 0.016, respectively) while infections occurred more often in nonpregnant women (36.1%) than in pregnant women (10.6%; P=0.003). Fifty (61.7%) patients with FHF died [25 (53.2%) pregnant women and 25 (69.5%) nonpregnant women (P=0.06)]. Cerebral oedema and HEV aetiology were independent variables of survival in patients with FHF. Patients with cerebral oedema had worse prognosis and patients with HEV aetiology had best chances of survival. Hence HEV was the most common cause of sporadic AVH in this endemic area. High proportion of pregnant women and increased severity of disease in pregnancy were limited to patients with hepatitis E. Sporadic AVH caused by agents other than HEV did not show any special predilection to or increased severity in pregnancy. FHF in pregnant women caused by HEV was an explosive disease with short pre- encephalopathy period, rapid development of cerebral oedema and high occurrence of disseminated intravascular coagulation and may represent a severe manifestation of a Schwartzmann-like phenomenon.

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Section: Discussionmentioning

confidence: 99%

Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy*

Khuroo

Kamili²

2003

Journal of Viral Hepatitis

283

208

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“…1,3 Pregnancy is the most significant prognostic factor for the occurrence of disseminated intravascular coagulation (DIC). 1,4 However, the pathogenesis of DIC in pregnant women with viral hepatitis is not known. Pregnant women with HEV infection and deranged coagulation profile pose a real obstetric challenge.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing occurrence of postpartum haemorrhage in pregnant women with hepatitis E infection and deranged coagulation profile

Puri¹,

Patra²,

Singh³

et al. 2011

Obstet Med

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Coagulopathy is an important complication associated with hepatitis E virus (HEV) infection in pregnant women. Postpartum haemorrhage (PPH) remains a serious risk while managing the labour of these women. The aim of this paper is to study the factors influencing the occurrence of PPH in pregnant women with hepatitis E infection with coagulopathy. The labours of 38 pregnant women with hepatitis E and deranged coagulation profile were followed. Factors that may predict postpartum bleeding complications in women with HEV infection and deranged coagulation profile were statistically analysed. Of 38 pregnant women with acute viral hepatitis due to HEV, 13 (34%) suffered a PPH while 25 (66%) did not. On univariate analysis low alanine aminotransferase (P = 0.016), high international normalized ratio (P = 0.003), high levels of d-dimer (P = 0.008), presence of hepatic encephalopathy (P = 0.028), intrauterine fetal death (P = 0.001) and gastrointestinal bleeding (P = 0.004) were found to predict PPH. However, on multivariate analysis the only independent variable that predicted PPH was the presence gastrointestinal (GI) bleeding (odds ratio [OR] 11.363; 95% CI: 1.003, 125; P = 0.050). Women with GI bleeding have 11 times higher risk of PPH than those without a GI bleed; however, the confidence interval is very wide. Administration of fresh frozen plasma in the peripartum period reduces the risk of PPH. In conclusion, early recognition of factors which predict the risk of PPH and timely intervention with judicious use of blood and blood components in the peripartum period can improve the outcome of pregnant women with HEV infection with deranged coagulation.

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Fulminant hepatic failure

Capocaccia¹,

Angélico²

1991

Digest Dis Sci

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A Study of Disseminated Intravascular Coagulopathy in Hepatic Coma Complicating Acute Viral Hepatitis

Cited by 4 publications

References 12 publications

Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy*

Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy*

Factors influencing occurrence of postpartum haemorrhage in pregnant women with hepatitis E infection and deranged coagulation profile

Fulminant hepatic failure

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