title: Etiological investigation of fatal liver failure during the course of chronic hepatitis B in southeast China.
abstract: BACKGROUND
  The purpose of this study was to clarify the relationships between patients who had fatal liver failure during the course of chronic hepatitis B and those who were also superinfected with hepatitis A, C, D, or E virus, as well as their hepatitis B virus e system status, so that suitable measures could be adopted to decrease the mortality of patients with chronic hepatitis B.
  
  
  METHODS
  This study detected superinfections of hepatitis A, C, D, or E virus and the hepatitis B virus e system status in cases of fatal liver failure during the course of chronic hepatitis B by enzyme-lined immunosorbent assay.
  
  
  RESULTS
  The frequency of superinfections of hepatitis A, C, D, and E virus was 1.4% (4/282), 6.4% (18/282), 1.8% (5/282), and 28.4% (80/282), respectively, overall, 37.9% (107/282). Hepatitis E was prominent and steady in superinfection rates during the past 12 years. In 62.1% (175/282) of patients, the causes of fatal liver failure were not clear. The serological status frequency of HBeAg(+) and anti-HBe(-), HBeAg(-) and anti-HBe(-), and HBeAg(-) and anti-HBe(+) was 20.6% (22/107), 23.4% (25/107), and 56.1% (60/107), respectively, in the group with superinfections of hepatitis A, C, D, or E virus and 31.4% (55/175), 21.1% (37/175), and 47.4% (83/175), respectively, in the group in which causes were not clear. The serological status HBeAg(+) and anti-HBe(-) was more frequent in the group in which causes were not clear than in the group with superinfections of hepatitis A, C, D, or E virus (P < 0.05). Statistically, there were no differences (P > 0.05) between the serological status HBeAg(-), anti-HBe(-) and HBeAg(-), anti-HBe(+) between the two groups.
  
  
  CONCLUSIONS
  These results suggest that superinfection (107/282) is an important factor in fatal liver failure. The mortality of chronic hepatitis B can be decreased by strict food sanitation and the use of safe blood products. There were no significant relationships between hepatitis B e antigen seroconversion and fatal liver failure during the course of chronic hepatitis B.
authors.affiliation: Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University, Shipai, Guangzhou 510630, P. R. China.
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Ke
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Li
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Yu
authors.forename: Jing
authors.initials: J
authors.lastname: Lai
authors.forename: Xiao-He
authors.initials: XH
authors.lastname: Li
authors.forename: Zhi-Liang
authors.initials: ZL
authors.lastname: Gao
authors.forename: Pei-Jia
authors.initials: PJ
authors.lastname: Chen
mesh_terms: D002681:China / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006506:Hepatitis A / Q000150:complications / Q000453:epidemiology; D006513:Hepatitis B e Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000401:mortality / Q000821:virology; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D003699:Hepatitis D / Q000150:complications / Q000453:epidemiology; D016751:Hepatitis E / Q000150:complications / Q000453:epidemiology; D006801:Humans; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015163:Superinfection / Q000150:complications / Q000453:epidemiology; D015996:Survival Rate
chemical_list: D006513:Hepatitis B e Antigens