title: Hepatitis E infection is an under recognized cause of acute decompensation in patients with chronic liver disease.
abstract: OBJECTIVE
  We aimed to assess characteristics of patients with a positive hepatitis E virus serology with emphasis on acute on chronic liver disease.
  
  
  METHODS
  This was a retrospective audit performed at a large teaching hospital.
  
  
  RESULTS
  Of the 164 patients tested, 15(9.1%) had a positive serology (hepatitis E virus IgG and or IgM) of whom two also had a positive hepatitis E virus RNA. Six (42.8%) had underlying chronic liver disease and presented with deteriorating liver tests±decompensation. In one patient (16%) acute hepatitis E virus infection was the aetiology for the decompensation and in three the positive hepatitis E virus IgG was a reflection of prior subclinical infection. However, in two of the six patients with unexplained decompensation there was delay (150-270 days) in obtaining a hepatitis E virus serology, which may have resulted in a negative hepatitis E virus IgM at time of testing.
  
  
  CONCLUSIONS
  9.1% of patients presenting with abnormal liver tests at a large teaching hospital in south east England have a positive hepatitis E virus serology of whom 42.8% have acute on chronic liver disease. In 16% hepatitis E virus infection is the aetiology for the acute decompensation. This may be an under representation as in >30% of patients with unexplained decompensation there is considerable delay in requesting a hepatitis E virus serology.
authors.affiliation: Department of Gastroenterology, Brighton and Sussex University Hospitals, Brighton, UK.
authors.forename: Sampath
authors.initials: S
authors.lastname: De Silva
authors.forename: Mohammed Osman
authors.initials: MO
authors.lastname: Hassan-Ibrahim
authors.forename: Mark
authors.initials: M
authors.lastname: Austin
authors.forename: Melanie
authors.initials: M
authors.lastname: Newport
authors.forename: Sumita
authors.initials: S
authors.lastname: Verma
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications; D005260:Female; D016751:Hepatitis E / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies