title: Characteristics of patients dying from acute viral hepatitis in Serbia.
abstract: OBJECTIVE
  Acute viral hepatitis is complicated rarely with severe liver failure due to many factors associated with the etiology, patient age, and time of development of hepatic encephalopathy, etc. The aim of this study was to identify some of the clinical and laboratory features associated with a fatal outcome in patients dying from acute viral hepatitis in Serbia.
  
  
  METHODS
  Clinical and laboratory data from 47 patients hospitalized from January 1989 December 2006 were reviewed retrospectively. Serological tests for hepatitis A, B, C, D, and E viruses, herpes simplex viruses, cytomegalovirus, and Epstein-Barr virus were done. Histological features were assessed from 35 liver tissues. The electronic base, SPSS for Windows (version 11.0), was used for statistical analysis.
  
  
  RESULTS
  The majority of the patients had alanine aminotransferase (ALT) >20x the normal value, serum bilirubin >300 μmol/L, prothrombin time >25 seconds (s), and white blood cell count >12 x 10(9)/L. Regression analysis revealed activity of alanine aminotransferase >20x the normal value to be associated with fulminant (p=0.015) and serum bilirubin concentration with subfulminant hepatitis (p=0.008). Hepatitis B virus was the most commonly detected virus (70%). Massive hepatocyte necrosis vs. sub-massive with bridging necrosis were found to be independent of clinical presentation.
  
  
  CONCLUSIONS
  Hepatitis B virus infection, severe impairment of liver function tests, and confluent hepatocyte necrosis and infection characterize patients dying from acute viral hepatitis in Serbia. High activity of alanine aminotransferase reflects rapid and extensive acute viral liver injury, while deep jaundice is more common in a protracted course of the disease.
authors.affiliation: Institute for Infectious and Tropical Diseases Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia, Yugoslavia. laslo@bitsyu.net
authors.forename: Neda
authors.initials: N
authors.lastname: Svirtlih
authors.forename: Dragan
authors.initials: D
authors.lastname: Delic
authors.forename: Jasmina
authors.initials: J
authors.lastname: Simonovic
authors.forename: Ljubisa
authors.initials: L
authors.lastname: Dokic
authors.forename: Eleonora
authors.initials: E
authors.lastname: Gvozdenovic
authors.forename: Olga
authors.initials: O
authors.lastname: Dulovic
authors.forename: Zorica
authors.initials: Z
authors.lastname: Nesic
authors.forename: Ivan
authors.initials: I
authors.lastname: Boricic
mesh_terms: D000328:Adult; D017677:Age Distribution; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000401:mortality* / Q000503:physiopathology / Q000821:virology; D019694:Hepatitis B, Chronic / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007565:Jaundice / Q000401:mortality / Q000503:physiopathology / Q000821:virology; D007958:Leukocyte Count; D017114:Liver Failure, Acute / Q000401:mortality* / Q000503:physiopathology / Q000821:virology; D008297:Male; D009336:Necrosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology; D017678:Sex Distribution
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin