title: Viral hepatitis-related acute liver failure.
abstract: OBJECTIVE
  Viral hepatitis has previously been the major cause of acute liver failure (ALF) in the United States. We aimed to determine the incidence of viral hepatitis-related ALF and to compare the outcome and clinical and biochemical variables in patients with hepatitis A and B.
  
  
  METHODS
  A total of 354 patients with ALF from multiple centers were screened for possible acute viral etiology.
  
  
  RESULTS
  Forty-three patients (12.1% of all ALF cases) had acute viral hepatitis: hepatitis A (n = 16), hepatitis B (n = 26), and herpes simplex virus infection (n = 1). There was no difference between groups with regard to age, gender, body mass index, admission or peak coma grade, symptom duration, admission mean arterial pressure, temperature, or biochemical liver tests, creatinine, arterial pH, or rate of infections. Platelet count was significantly higher in hepatitis A patients than in hepatitis B patients. The transplantation-free (spontaneous) survival rate was significantly higher for hepatitis A patients (69%) than for hepatitis B patients (19%, p = 0.007), whereas the liver transplantation rate was higher in hepatitis B patients (62%) than in hepatitis A patients (19%, p = 0.017). Spontaneous survivors had significantly higher mean arterial pressure, higher platelet count, and lower AST/ALT ratio than patients who did not survive spontaneously.
  
  
  CONCLUSIONS
  Viral hepatitis now comprises only one-eighth of all ALF cases in the United States. The marked difference in spontaneous survival between hepatitis A and B cannot be explained by the severity of hepatic dysfunction on admission but may rather be an inherent feature of the infections or a bias toward transplanting patients with hepatitis B.
authors.affiliation: Department of Gastroenterology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Frank Vinholt
authors.initials: FV
authors.lastname: Schiødt
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Davern
authors.forename: A Obaid
authors.initials: AO
authors.lastname: Shakil
authors.forename: Brendan
authors.initials: B
authors.lastname: McGuire
authors.forename: Grace
authors.initials: G
authors.lastname: Samuel
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D006506:Hepatitis A / Q000150:complications* / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase