Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death

Acharya, Subrat Kumar; Sharma, Praveen; Singh, Rajbir; Mohanty, Sujit K.; Madan, Kaushal; Jha, Jyotish Kumar; Panda, Subrat Kumar

doi:10.1016/j.jhep.2006.09.016

Cited by 252 publications

(190 citation statements)

References 33 publications

(58 reference statements)

Supporting

Mentioning

179

Contrasting

Unclassified

Order By: Relevance

“…6 Superimposed viral infections with hepatotropic viruses in patients with cirrhosis can have devastating consequences by direct hepatocellular damage. Perhaps, the best examples are HEVsuperinfection 15 and reactivation of hepatitis B virus (HBV) in patients on immunosuppression. 16 …”

Section: Concept Of Acute-on-chronic Liver Failurementioning

confidence: 99%

“…17 Subsequently, many publications have reported HEV as one of the leading causes for decompensation of cirrhosis from Asia and Africa, where HEV is endemic (Table 1). 14,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Most of these studies have used the APASL definition of ACLF and in median21% of cases (range 4-72%) of ACLF, HEV was the precipitating cause for liver decompensation. This contrasts with the Western countries where HEV is rarely the precipitating cause of acute decompensation in ACLF.…”

Section: Role Of Hepatitis E Virus In Acute-on-chronic Liver Failurementioning

confidence: 99%

“…While in the two of the large studies from India the mortality rate was about 44%. 15,26 Multi-organ failure has been the main cause of death in all the studies.…”

Section: Clinical Features and Prognosis Of Hev-related Aclfmentioning

confidence: 99%

See 2 more Smart Citations

Hepatitis E and Acute-on-Chronic Liver Failure

Kumar

Saraswat

2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis (AVH) globally. It causes large scale epidemics of AVH across the low-and middle income countries in Asia and Africa, and also causes sporadic cases of AVH in the same geographical region. AVH due to HEV is usually an acute, self-limiting illness, similar in clinical presentation to AVH caused by hepatitis A virus (HAV). When HEV causes AVH in patients of chronic liver disease it may worsen rapidly to a syndrome called acute-on-chronic liver failure (ACLF) leading to very high mortality. Acute deterioration of liver function in a patient with compensated chronic liver disease is the characteristic feature of ACLF. The typical disease course of patients with ACLF is the appearance of organ failure, which progresses to multi-organ failure and death. Many publications have reported HEV as one of the leading causes for ACLF from Asia and Africa, where HEV is endemic. The mortality rate of HEV-related ACLF (HEV-ACLF) ranges from 0% to 67% with a median being 34%. These patients require admission in the intensive care unit and they benefit from a team approach of clinicians with expertise in both hepatology and critical care. The goals of treatment are to prevent further deterioration in liver function, reverse precipitating factors, and support failing organs. Liver transplantation is required in selected patients to improve survival and quality of life. One preliminary report suggests that ribavirin may be an effective and safe drug for treatment of HEV-ACLF however this requires validation in large trials. ( J CLIN EXP HEPATOL 2013;3:225-230)

show abstract

Section: Concept Of Acute-on-chronic Liver Failurementioning

confidence: 99%

Section: Role Of Hepatitis E Virus In Acute-on-chronic Liver Failurementioning

confidence: 99%

See 1 more Smart Citation

Hepatitis E and Acute-on-Chronic Liver Failure

Kumar

Saraswat

2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…[78][79][80] The mortality rate among such patients is higher than that observed in patients with usual hepatitis E. 80 …”

Section: Clinical Outcomes In High-endemicity Areasmentioning

confidence: 99%

Hepatitis E: Epidemiology and Natural History

Aggarwal

2013

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

“…However, severe disease with fatal outcome is observed in pregnant women 11 or in patients with preexisting chronic liver diseases. 12,13 In immunosuppressed patients especially after (solid) organ transplantation, HEV infection may become chronic. [14][15][16] Unexplained liver injury after liver transplantation prompts a diagnostic work-up which in many instances includes a liver biopsy 17 and also testing for (viral) infections, but screening for HEV is still not routinely done in Europe.…”

mentioning

confidence: 99%

Molecular detection of hepatitis E virus (HEV) in liver biopsies after liver transplantation

et al. 2015

View full text Add to dashboard Cite

We aimed to determine the rate of hepatitis E virus (HEV) infection, a recently increasingly recognized disease in the Western world, in liver transplant patients by direct molecular testing of liver tissue. A RT-PCR assay was designed for detecting the HEV open reading frame (ORF) 2/3 gene region in formalin-fixed, paraffin-embedded tissues, and applied to all liver biopsies (n ¼ 683) taken 4 weeks or later from all patients (n ¼ 282) after liver transplantation of two large academic centers. HEV-RNA was detected in ten biopsies from four different patients (rate: 1%). Histology in early HEV infection was variable including cases with only few hepatocellular apoptoses, no or only minute inflammation. Hepatitis lasted for at least 6 months in 3/4 patients. Serologic testing for HEV-RNA in a subcohort (159 patients) was positive in five patients (rate: 3%), resulting in an overall HEV detection rate of 3% (8/282). In case both liver tissue and sera of a patient were available from the same time period, all cases tested positive in one material were also tested positive in the other material, respectively. All patients had de novo autochthonous infection with HEV genotype 3. Our data confirm that HEV infection is a relevant cause of liver injury after liver transplantation. Molecular testing for HEV in routinely processed transplant liver biopsies is powerful for evaluating patients with elevated transaminases of unknown origin. Histology of HEV infection under immunosuppression in the early phase is distinct from HEV infection in immunocompetent individuals.

show abstract

Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death

Cited by 252 publications

References 33 publications

Hepatitis E and Acute-on-Chronic Liver Failure

Hepatitis E and Acute-on-Chronic Liver Failure

Hepatitis E: Epidemiology and Natural History

Molecular detection of hepatitis E virus (HEV) in liver biopsies after liver transplantation

Contact Info

Product

Resources

About