title: Hepatitis E infection in patients with severe alcoholic hepatitis: is there a place for systematic screening?
abstract: BACKGROUND
  One study has suggested that markers of acute hepatitis E virus (HEV) infection are present in 3.6% of patients with severe alcoholic hepatitis (AH). However, validation of these preliminary results is lacking, as well as the impact of HEV infection on the 6-month survival.
  
  
  OBJECTIVE
  The aims of this study were to evaluate the prevalence of HEV infection markers in an external cohort of patients with histologically proven severe AH and to assess the impact of markers of acute HEV infection on the 6-month survival and the need for liver transplantation (LT).
  
  
  METHODS
  Patients admitted for severe AH from January 2008 to June 2014 were analysed. HEV serology (IgM and IgG) was retrospectively performed.
  
  
  RESULTS
  Ninety-three patients were analysed (male sex 77.4%, age 53±9 years, Maddrey discriminant function 65±32, MELD score 24±6). Six patients (6.5%) had markers of acute HEV infection (IgM+and IgG+), 11 (11.8%) of past HEV infection (IgG+and IgM-) and 76 (81.7%) had a negative serology (IgM- and IgG-). Initial presentation and biological characteristics were not different between IgM+ and IgM- patients, except for the aspartate aminotransferase level (P<0.001). Markers of acute HEV infection had no impact on response to corticosteroids, 1-, 3- or 6-month survival, and the need for LT. Three patients showed symptomatic acute HEV at onset of acute AH: two were treated with ribavirin during the acute phase: one patient died and one patient underwent LT.
  
  
  CONCLUSIONS
  Markers of acute HEV infection were present in 6.5% of patients in our cohort of cirrhotics with histologically proven severe AH, without any impact on short-term or long-term outcome. Whether systematic screening of acute HEV infection in this population should be performed remains an unsolved question.
authors: aAP-HP, UPMC, Department of Hepatology and Gastroenterology bAP-HP, UPMC, Department of Virology cAP-HP, UPMC, Department of Anatomopathology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France.
authors: Marika
authors: M
authors: Rudler
authors: Vincent
authors: V
authors: Thibault
authors: Sarah
authors: S
authors: Mouri
authors: Sepideh
authors: S
authors: Akhavan
authors: Maxime
authors: M
authors: Mallet
authors: Frédéric
authors: F
authors: Charlotte
authors: Thierry
authors: T
authors: Poynard
authors: Dominique
authors: D
authors: Thabut
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D016751:Hepatitis E / Q000150:complications* / Q000175:diagnosis*; D016752:Hepatitis E virus / Q000276:immunology; D006519:Hepatitis, Alcoholic / Q000150:complications* / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D005938:Glucocorticoids; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012254:Ribavirin