title: Determinants of poor outcome in patients with hepatitis A infection: a four-year retrospective study in Shiraz, Southern Iran.
abstract: There are 1.4 million estimated cases of hepatitis A every year worldwide. We aimed to detect the correlates of poor outcome in patients with hepatitis A virus (HAV) infection. In this four-year retrospective study, which was conducted in Shiraz, Southern Iran, data of all hospitalized HAV patients were analyzed by SPSS and STATA. Out of 110 HAV patients, 8 (7.3 %) developed hepatic encephalopathy, and 7 (6.4 %) died. The results show that 19 years of age is a cutoff level for predicting mortality, with a sensitivity of 42.9 % and specificity of 91.3 %, and with an area under the curve (AUC) of 0.595 (95 % CI, 0.309-0.881). Every one-year increase in age adds 3 % to the mortality rate from severe hepatitis A. The cutoff level of alanine aminotransferase (ALT) for predicting death is 1819.5 IU/L, with a sensitivity of 100 %, specificity of 68 %, and AUC 0.877 (95 % CI, 0.777-0.977). Every 100 IU/L increase in ALT is associated with a 0.1 % increase in the risk of death. Patients from large families (OR, 0.583, 95 % CI, 0.46-0.74) and those who are not the firstborn child of their family (OR, 0.287, 95 % CI, 0.146-0.564) have better outcome. Adult patients with hepatitis A who are first children, are from a small family, or have a very high level of ALT are more prone to a poor outcome of this infection. Public education and establishment of a national surveillance system for HAV and an HAV vaccination program for high-risk populations should be regarded among the priorities of the health system of Iran.
authors.affiliation: Community and Preventive Medicine, Health Policy Research Centre, Shiraz University of Medical Sciences, School of Medicine, Building No 2, 8th Floor, Zand Blvd, 7134853185, Shiraz, Iran.
authors.forename: Kamran B
authors.initials: KB
authors.lastname: Lankarani
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mahmoodi
authors.forename: Behnam
authors.initials: B
authors.lastname: Honarvar
authors.forename: Parastoo
authors.initials: P
authors.lastname: Nematollahi
authors.forename: Nima
authors.initials: N
authors.lastname: Zamiri
authors.forename: Fariborz
authors.initials: F
authors.lastname: Ghaffarpasand
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006506:Hepatitis A / Q000097:blood / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D030041:Hepatitis A virus / Q000502:physiology*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000410:Alanine Transaminase