title: Comparison of acute hepatitis E infection outcome in patients with and without chronic hepatitis B infection: a 10 year retrospective study in three regional hospitals in Hong Kong.
abstract: BACKGROUND
  Acute hepatitis E virus (HEV) infection has recently become the commonest cause of acute viral hepatitis in Hong Kong (HK) with majority of HEV belonging to genotype 4. Studies from China have shown that acute hepatitis E patients with underlying chronic hepatitis B virus (HBV) infection may have a worse outcome than those without. In India where genotype 1 is more prevalent, superinfection with hepatitis E on patients with chronic liver disease including chronic hepatitis B infection can cause liver decompensation.
  
  
  OBJECTIVE
  The study aims to determine the clinical outcome of acute hepatitis E infection in patients with and without chronic hepatitis B infection in HK.
  
  
  METHODS
  The rates of liver failure, liver-related mortality and all-cause mortality will be compared between acute hepatitis E patients with and without chronic hepatitis B. Analysis was performed using the Statistical Package for the Social Science (SPSS version 12.0). All statistical tests were two-sided, and statistical significance was taken as p<0.05.
  
  
  RESULTS
  Chronic HBV carriers with acute HEV infection were found to have higher liver failure rate, liver-related mortality and all-cause mortality, but the results did not reach statistical significance. Chronic HBV carriers were found to have statistically significantly lower admission ALT level, lower day 28 serum albumin level and higher day 28 serum ALT level.
  
  
  CONCLUSIONS
  A prospective study with sufficient sample size is needed to confirm whether the clinical outcome of patients with chronic HBV infection is worse compared with patients who were not chronic HBV carriers.
authors.affiliation: Department of Medicine, Tseung Kwan O Hospital, Hong Kong Special Administrative Region. Electronic address: ccw315@ha.org.hk.
authors.forename: Chi-Wing
authors.initials: CW
authors.lastname: Chow
authors.affiliation: Department of Medicine, Tseung Kwan O Hospital, Hong Kong Special Administrative Region.
authors.forename: Steven Woon-Choy
authors.initials: SW
authors.lastname: Tsang
authors.affiliation: Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region.
authors.forename: Owen Tak-Yin
authors.initials: OT
authors.lastname: Tsang
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong Special Administrative Region.
authors.forename: Vincent King-Sun
authors.initials: VK
authors.lastname: Leung
authors.affiliation: Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region.
authors.forename: Kitty Sau-Chun
authors.initials: KS
authors.lastname: Fung
authors.affiliation: Department of Clinical Pathology, Tseung Kwan O Hospital, Hong Kong Special Administrative Region.
authors.forename: Wei-Kwang
authors.initials: WK
authors.lastname: Luk
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong Special Administrative Region.
authors.forename: Tai-Nin
authors.initials: TN
authors.lastname: Chau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D016751:Hepatitis E / Q000401:mortality* / Q000473:pathology*; D006723:Hong Kong / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D017093:Liver Failure / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: All-cause mortality; Hepatitis B; Hepatitis E; Liver failure; Liver-related mortality