title: Hepatitis E virus in patients with decompensated chronic liver disease: a prospective UK/French study.
abstract: BACKGROUND
  In developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genotype 3. In developing countries, hepatitis E is mainly caused by genotype 1, and causes increased mortality in patients with pre-existing chronic liver disease (CLD).
  
  
  OBJECTIVE
  To determine the role of HEV in patients with decompensated CLD.
  
  
  METHODS
  Prospective HEV testing of 343 patients with decompensated CLD at three UK centres and Toulouse France, with follow-up for 6 months or death. IgG seroprevalence was compared with 911 controls.
  
  
  RESULTS
  11/343 patients (3.2%) had acute hepatitis E infection, and three died. There were no differences in mortality (27% vs. 26%, OR 1.1, 95% CI 0.28-4.1), age (P = 0.9), bilirubin (P = 0.5), alanine aminotransferase (P = 0.06) albumin (P = 0.5) or international normalised ratio (P = 0.6) in patients with and without hepatitis E infection. Five cases were polymerase chain reaction (PCR) positive (genotype 3). Hepatitis E was more common in Toulouse (7.9%) compared to the UK cohort (1.2%, P = 0.003). HEV IgG seroprevalence was higher in Toulouse (OR 17, 95% CI 9.2-30) and Truro (OR 2.5, 95% CI 1.4-4.6) than in Glasgow, but lower in cases, compared to controls (OR 0.59, 95% CI 0.41-0.86).
  
  
  CONCLUSIONS
  Hepatitis E occurs in a minority of patients with decompensated chronic liver disease. The mortality is no different to the mortality in patients without hepatitis E infection. The diagnosis can only be established by a combination of serology and PCR, the yield and utility of which vary by geographical location.
authors.affiliation: Service d'Hépato-Gastro-Entérologie, Hôpital Purpan, Université Paul Sabatier III, Toulouse, France.
authors.forename: H
authors.initials: H
authors.lastname: Blasco-Perrin
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Madden
authors.affiliation: Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Stanley
authors.affiliation: Glasgow Caledonian University, Glasgow, UK.
authors.forename: C
authors.initials: C
authors.lastname: Crossan
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Hunter
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: L
authors.initials: L
authors.lastname: Vine
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: K
authors.initials: K
authors.lastname: Lane
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: N
authors.initials: N
authors.lastname: Devooght-Johnson
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: C
authors.initials: C
authors.lastname: Mclaughlin
authors.affiliation: Scottish National Blood Transfusion Service, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Petrik
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: B
authors.initials: B
authors.lastname: Stableforth
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: H
authors.initials: H
authors.lastname: Hussaini
authors.affiliation: Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: M
authors.initials: M
authors.lastname: Phillips
authors.affiliation: Laboratoire de virologie, Hôpital Purpan, CHU de Toulouse, Toulouse, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Mansuy
authors.affiliation: Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: E
authors.initials: E
authors.lastname: Forrest
authors.affiliation: Laboratoire de virologie, Hôpital Purpan, CHU de Toulouse, Toulouse, France.|INSERM, U1043, Toulouse, France.|Université Toulouse III Paul Sabatier, Toulouse, France.
authors.forename: J
authors.initials: J
authors.lastname: Izopet
authors.affiliation: Health Protection Scotland, Glasgow, UK.
authors.forename: O
authors.initials: O
authors.lastname: Blatchford
authors.affiliation: Glasgow Caledonian University, Glasgow, UK.
authors.forename: L
authors.initials: L
authors.lastname: Scobie
authors.affiliation: Service d'Hépato-Gastro-Entérologie, Hôpital Purpan, Université Paul Sabatier III, Toulouse, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Peron
authors.affiliation: Royal Cornwall Hospital Trust, Truro, UK.
authors.forename: H R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D058625:End Stage Liver Disease / Q000453:epidemiology / Q000821:virology*; D005260:Female; D005602:France / Q000453:epidemiology; D005838:Genotype; D016751:Hepatitis E / Q000175:diagnosis; D016752:Hepatitis E virus / Q000235:genetics; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007074:Immunoglobulin G; D000410:Alanine Transaminase; D001663:Bilirubin