title: Hepatitis E infection in patients with severe acute alcoholic hepatitis.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) infection is a known cause of acute-on-chronic liver failure in developing countries, but its implication in Western countries remains unknown. HEV burden in the setting of severe acute alcoholic hepatitis (AAH) was assessed.
  
  
  METHODS
  Patients admitted for severe AAH from 2007 to 2013, with available sera and histologically proven AAH, were included and managed according to current European guidelines. At admission, clinical and biological characteristics were collected; HEV serology and RNA detection were retrospectively performed.
  
  
  RESULTS
  Eighty-four patients were included. Mean age was 50.8 ± 9.6 years, 65.5% were male, 91.7% were cirrhotic and 33.3% presented with encephalopathy. Mean MELD and Maddrey scores were respectively 32.4 ± 11.4 and 73.3 ± 37. Liver biopsy showed mild, moderate and severe hepatitis in 25 (29.8%), 23 (27.4%) and 32 (38.1%) patients respectively. Steroids were given to 61 patients (72.6%) of whom 35 (57.4%) presented corticoresistance (mean Lille score: 0.78 ± 0.21). During hospitalization, 24 patients (28.6%) died and 11 (13.1%) were transplanted. Three patients (3.6%) presented markers of acute HEV infection and 21 (25%) markers of past HEV infection. Patient with acute infection were men, cirrhotic, and 2/3 presented with encephalopathy. Steroids were given to two patients without any response. The third patient died. None were transplanted.
  
  
  CONCLUSIONS
  A substantial proportion of patients with severe AAH had markers of acute HEV infection, with similar clinical presentation and outcomes. Larger studies are needed to evaluate HEV impact on AAH management, resistance to steroids, and outcome.
authors.affiliation: Virologie, CNR des hépatites A et E, AP-HP, Hôpital Paul Brousse, Villejuif, 94804, France; UMR-S 785, Univ Paris-Sud, Le Kremlin Bicêtre, 94275, France; INSERM U785, Villejuif, 94804, France; Hepatinov, Villejuif, F94800, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Haim-Boukobza
authors.forename: Audrey
authors.initials: A
authors.lastname: Coilly
authors.forename: Mylène
authors.initials: M
authors.lastname: Sebagh
authors.forename: Mouna
authors.initials: M
authors.lastname: Bouamoud
authors.forename: Teresa
authors.initials: T
authors.lastname: Antonini
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Olga
authors.initials: O
authors.lastname: Yordanova
authors.forename: Janine
authors.initials: J
authors.lastname: Savary
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Duclos-Vallee
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Roque-Afonso
mesh_terms: D000208:Acute Disease; D065290:Acute-On-Chronic Liver Failure / Q000821:virology; D000328:Adult; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000821:virology; D016751:Hepatitis E / Q000150:complications* / Q000175:diagnosis*; D016752:Hepatitis E virus; D006519:Hepatitis, Alcoholic / Q000150:complications* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use
chemical_list: D013256:Steroids
keywords: acute alcoholic hepatitis; cirrhosis; corticoresistance; hepatitis E; lille score