title: Clinical course and management of acute hepatitis A infection in adults.
abstract: BACKGROUND
  Hepatitis A is the most common type of viral hepatitis in Mexico. The change of hepatitis A epidemiology in Mexico from high to intermediate endemicity leads to increasing susceptible adults for severe illness.
  
  
  OBJECTIVE
  To describe the clinical characteristics and hospital outcome of adult patients with acute hepatitis A infection, and determine risk factor for mortality.
  
  
  METHODS
  This is a retrospective observational, multicentre study in Mexico City and in Guatemala City. All inhospital patients were followed until discharge or death. Risk factors for death/acute liver failure were identified.
  
  
  RESULTS
  Forty seven patients were analyzed, sixty percent were male, the prodrome phase was from 3 to 30 days. The three most common symptoms were fever, malaise and jaundice, with 87%, 74% and 62% respectively. The incidence of patients who were treated with antibiotics before hospital admission was up to 34%. Unnecessary imaging studies and out of guidelines drugs were used. Presence of encephalopathy, leukocytes > 19,000/mL, blood urea nitrogen > 36 mg/dL, creatinine > 2 mg/dL, albumin < 2.5 mg/dL and total bilirubin > 9.6 mg/dL, are predictors of mortality. Serum creatinine > 2 mg/dL has the best sensibility and specificity for predicting fulminant hepatitis/death.
  
  
  CONCLUSIONS
  Acute hepatitis A infection in adults is associated some unnecessary diagnostic and therapeutic approach. Could be associated with fulminant hepatitis, and a creatinine value > 2 mg/dL is the best predictor for fulminant hepatitis and death.
authors.affiliation: Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico.
authors.forename: Ileana
authors.initials: I
authors.lastname: Mackinney-Novelo
authors.forename: Josué
authors.initials: J
authors.lastname: Barahona-Garrido
authors.forename: Fátima
authors.initials: F
authors.lastname: Castillo-Albarran
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Santiago-Hernández
authors.forename: Nahum
authors.initials: N
authors.lastname: Méndez-Sánchez
authors.forename: Misael
authors.initials: M
authors.lastname: Uribe
authors.forename: Norberto
authors.initials: N
authors.lastname: Chávez-Tapia
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006506:Hepatitis A / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D015415:Biomarkers