Acute hepatitis A virus infection: a review of prognostic factors from 25 years experience in a tertiary referral center.
OBJECTIVE
Hepatitis A is usually a mild, self-limiting illness but can result in severe or fatal disease. We reviewed 25 years experience to determine what factors predispose to severe or fatal disease.


METHODS
We identified 97 patients admitted between 1974-1999 with acute hepatitis A. Clinical, biochemical and histological data were correlated with outcome and patients were screened for evidence of hepatitis B or C virus coinfection and coexisting autoimmunity.


RESULTS
Fifty-five patients had liver failure with hepatic encephalopathy of whom 29 died and 6 underwent liver transplantation. Patients with liver failure were significantly older than those without (mean age: 42.2 +/- 13.3 vs. 29.2 +/- 7.8, P = 0.0001), and liver failure patients who died were older than those surviving (47.5 +/- 12.7 vs. 36.3 +/- 11.6, P = 0.0001). Hyperacute liver failure predicted good outcome (P = 0.0001). Three patients with viral coinfection had established cirrhosis and died. Detectable autoantibodies did not correlate with outcome or severity. Patients acquiring infection abroad were more likely to have liver failure than those acquiring infection in the UK (P = 0.023).


CONCLUSIONS
Age is the best predictor for outcome in patients with liver failure from hepatitis A. Underlying chronic liver disease, and the time of onset of encephalopathy are also factors affecting outcome. Infection acquired abroad has a worse prognosis.
Kyrlagkitsis
Ioannis
I
Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK. verdi@compulink.gr
Cramp
Matthew E
ME
Smith
Heather
H
Portmann
Bernard
B
O'Grady
John
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis; D000974:Antibodies, Antinuclear / Q000032:analysis; D005260:Female; D006506:Hepatitis A / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006513:Hepatitis B e Antigens / Q000032:analysis; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
D000906:Antibodies; D000974:Antibodies, Antinuclear; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens