title: Fulminant hepatitis A virus infection in the United States: Incidence, prognosis, and outcomes.
abstract: Acute liver failure (ALF) due to hepatitis A virus (HAV) infection is an uncommon but potentially lethal illness. The aim of this study was to identify readily available laboratory and clinical features associated with a poor prognosis among ALF patients with HAV infection. The presenting features of 29 adults with anti-HAV IgM positive ALF enrolled in the ALFSG_between 1998 and 2005 were reviewed. The HAV patients listed for transplantation by UNOS were also reviewed. Acute HAV accounted for 3.1% of patients enrolled in the ALFSG. At 3 weeks follow-up, 16 had spontaneously recovered (55%), 9 underwent transplantation (31%), and 4 had died (14%). A prognostic model incorporating 4 presenting features (serum ALT <2,600 IU/L, creatinine >2.0 mg/dL, intubation, pressors) had an AUROC for transplant/death of 0.899 which was significantly better than the King's College criteria (0.623, P = .018) and MELD scores (0.707, P = .0503). Between 1988 and 2005, the frequency of patients requiring liver transplantation for HAV in the UNOS database significantly decreased from 0.7 % to 0.1% (P < .001). In addition, the proportion of HAV cases enrolled in the ALFSG significantly decreased from 5% to 0.8% (P = .007). In conclusion, the frequency of HAV patients enrolling in the ALFSG and being listed for liver transplantation in the United States has declined in parallel. A prognostic index consisting of 4 clinical and laboratory features predicted the likelihood of transplant/death significantly better than other published models suggesting that disease specific prognostic models may be of value in non-acetaminophen ALF.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0362, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Taylor
authors.forename: Timothy
authors.initials: T
authors.lastname: Davern
authors.forename: Santiago
authors.initials: S
authors.lastname: Munoz
authors.forename: Stephen-Huy
authors.initials: SH
authors.lastname: Han
authors.forename: Brendan
authors.initials: B
authors.lastname: McGuire
authors.forename: Anne M
authors.initials: AM
authors.lastname: Larson
authors.forename: Linda
authors.initials: L
authors.lastname: Hynan
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006506:Hepatitis A / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D017114:Liver Failure, Acute / Q000453:epidemiology* / Q000209:etiology; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology