title: Serum tumor necrosis factor-alpha level in hepatitis E virus-related acute viral hepatitis and fulminant hepatic failure in pregnant women.
abstract: OBJECTIVE
  The host response in hepatitis E virus (HEV)-related liver disease of pregnant women is unclear. This study was carried out to evaluate the serum concentration of tumor necrosis factor (TNF)-α in HEV-related acute viral hepatitis (AVH) and fulminant hepatic failure (FHF) in pregnant women in relation to pregnancy outcome.
  
  
  METHODS
  The study included 262 pregnant and 158 non-pregnant women with jaundice. There were 160 healthy asymptomatic pregnant women and 124 healthy asymptomatic non-pregnant women as controls. The jaundiced patients were classified as AVH or FHF. Serum TNF-α level was assayed by commercially available enzyme-linked immunoassay kits.
  
  
  RESULTS
  A significantly higher level of TNF-α was observed in HEV-infected pregnant women than non-HEV pregnant women (P < 0.001). TNF-α level was significantly higher in AVH and FHF of HEV-infected pregnant women compared with AVH and FHF of HEV infected non-pregnant women (P = 0.036 and P = 0.010, respectively). The HEV-infected pregnant FHF expired group had significantly higher levels of TNF-α than the non-pregnant FHF expired group (P = 0.025). TNF-α levels were significantly higher in AVH of HEV-infected pregnant women than healthy pregnant controls (P < 0.001). Higher TNF-α levels were observed in HEV-infected women having preterm delivery and low birthweight newborns compared with non-HEV and healthy pregnant women.
  
  
  CONCLUSIONS
  Higher serum concentration of TNF-α observed in HEV infected AVH and FHF pregnant cases shows that pregnancy with HEV infection increases TNF-α secretion. TNF-α may be an important factor in the outcomes of pregnancy due to HEV infection.
authors.affiliation: Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
authors.forename: Gyaneshwori Devi
authors.initials: GD
authors.lastname: Salam
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Premashis
authors.initials: P
authors.lastname: Kar
authors.forename: Sarita
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Akhtar
authors.initials: A
authors.lastname: Husain
authors.forename: Shashi
authors.initials: S
authors.lastname: Sharma
keywords: acute viral hepatitis; fulminant hepatic failure; hepatitis E virus; non-pregnant; pregnant; tumor necrosis factor-α