Hepatitis E virus a common underlying cause of acute-on-chronic liver failure

02 Dec 2018
Hepatitis E virus a common underlying cause of acute-on-chronic liver failure

Alcohol contributes largely to the development of acute-on-chronic liver failure (ACLF), whereas hepatitis E virus (HEV) is the most common infectious cause of ACLF, suggesting a need for vaccination in such patients, a study has found.

Researchers examined 50 ACLF patients and 50 patients with stable chronic liver disease (CLD; controls), the majority of which were 31–60 years of age and male. They collected blood samples and performed two anti-HEV IgM enzyme-linked immunosorbent assays (ELISA; detection and capture). Additionally, they quantified HEV RNA in plasma and stool.

Results revealed ethanol to be the most common cause of acute insult in ACLF patients (54 percent), followed by HEV infection (14 percent).

IgM detection ELISA detected positivity for IgM antibodies to HEV in 10 ACLF patients vs two controls (20 percent vs 4 percent; p=0.0138). Only one ACLF patient showed HEV viremia (403 IU/ml), faecal shedding (2,790 IU/ml) and HEV antigenemia.

On the other hand, IgM capture ELISA detected five patients and one control. Agreement between detection and capture assays was 0.638 (kappa value).

The present data demonstrate a significant role of HEV in the causation of ACLF, highlighting a need to have an expanded diagnostic approach for HEV in such individuals, researchers said.

Researchers also pointed out that the time of presentation is of essence in the laboratory diagnosis of HEV. In the cohort, viremia, faecal shedding, antigenemia and IgM positivity were detected in one ACLF patient who presented on the fourth day of illness. In previous studies, 100 percent positivity for HEV RNA and antigen was observed in the first 3 days of illness, while the rate decreased by 46 percent for HEV RNA detection and by 12 percent for antigen detection by day 7 of illness. [J Med Virol 2013;85:823-827]

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