title: Clinical features and risk factors of acute hepatitis E with severe jaundice.
abstract: OBJECTIVE
  To compares the clinical features of patients infected with hepatitis E virus (HEV) with or without severe jaundice. In addition, the risk factors for HEV infection with severe jaundice were investigated.
  
  
  METHODS
  We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group. Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum. We used χ(2) analysis, Fisher's exact test, and Student's t test where appropriate in this study. Significant predictors in the univariate analysis were then included in a forward, stepwise multiple logistic regression model.
  
  
  RESULTS
  No significant differences in symptoms, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or hepatitis B virus surface antigen between the two groups were observed. HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase (GGT) (median: 170.31 U/L vs 237.96 U/L, P = 0.007), significantly lower ALB levels (33.84 g/L vs 36.89 g/L, P = 0.000), significantly lower acetylcholine esterase (CHE) levels (4500.93 U/L vs 5815.28 U/L, P = 0.000) and significantly higher total bile acid (TBA) levels (275.56 μmol/L vs 147.03 μmol/L, P = 0.000) than those without severe jaundice. The median of the lowest point time tended to be lower in patients with severe jaundice (81.64% vs 96.12%, P = 0.000). HEV infected patients with severe jaundice had a significantly higher viral load (median: 134 vs 112, P = 0.025) than those without severe jaundice. HEV infected patients with severe jaundice showed a trend toward longer median hospital stay (38.17 d vs 18.36 d, P = 0.073). Multivariate logistic regression indicated that there were significant differences in age, sex, viral load, GGT, albumin, TBA, CHE, prothrombin index, alcohol overconsumption, and duration of admission between patients infected with acute hepatitis E with and without severe jaundice.
  
  
  CONCLUSIONS
  Acute hepatitis E patients may naturally present with severe jaundice.
authors: Liver and Endocrine Diseases Ward of Beijing Youan Hospital, Capital Medical University, Beijing 100069, China. xubin1016@yahoo.cn
authors: Bin
authors: B
authors: Xu
authors: Hai-Bin
authors: HB
authors: Yu
authors: Wei
authors: W
authors: Hui
authors: Jia-Li
authors: JL
authors: He
authors: Lin-Lin
authors: LL
authors: Wei
authors: Zheng
authors: Z
authors: Wang
authors: Xin-Hui
authors: XH
authors: Guo
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000378:metabolism; D016751:Hepatitis E / Q000150:complications* / Q000175:diagnosis*; D016752:Hepatitis E virus / Q000378:metabolism; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007565:Jaundice / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012044:Regression Analysis; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens; D007075:Immunoglobulin M; D012367:RNA, Viral; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Acute hepatitis E; Clinical features; Hepatitis E virus; Risk factor; Severe jaundice