title: Acute Liver Failure Due to Hepatitis E Virus Infection Is Associated with Better Survival than Other Etiologies in Indian Patients.
abstract: Hepatitis E virus (HEV) is a global disease and an important cause of acute liver failure (ALF) in the Indian subcontinent. The aim of this study was to assess the differences in the course of HEV-ALF as compared to other etiologies of ALF.
  
  
  
  We compared the clinical course, complications, and outcomes of HEV-ALF with other etiologies. We assessed the prognostic factors and compared existing prognostic scores in HEV-ALF patients.
  
  
  
  One thousand four hundred and sixty-two ALF patients were evaluated between January 1986 and December 2015. HEV was the etiology of ALF in 419 (28.7%) cases, whereas non-A non-E hepatitis, HBV and anti-tuberculosis therapy (ATT) were the etiologies in 527 (36.0%), 128 (8.8%), and 103 (7.0%) cases, respectively. The frequency of cerebral edema in HEV-ALF (41.3%) was lower than that in non-A non-E ALF (52.9%; P < 0.001) and HBV-ALF (52.8%; P = 0.024). Infection and seizures were significantly less in patients with HEV-ALF compared to non-A non-E and HBV-ALF (P = 0.038 and 0.022, respectively). The survival of HEV-ALF patients was significantly better (55.1%, P < 0.001) than patients of other etiologies-including ATT (30.0%), non-A non-E (38.1%) and HBV (35.9%). In HEV-ALF patients, age, female sex, cerebral edema, prothrombin time >60 s, infection, and total bilirubin were observed as independent predictors of outcome on multivariate logistic regression analysis. Model for end-stage liver disease, acute liver failure study group model and King's College Hospital criteria had poor discriminative accuracy for outcome (area under receiver operator characteristic curve 0.63-0.64) in HEV-ALF.
  
  
  
  Hepatitis E virus-associated ALF has a better outcome than ALF of other etiologies.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.lastname: Shalimar
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kedia
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gunjan
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ujjwal
authors.initials: U
authors.lastname: Sonika
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Soumya Jagannath
authors.initials: SJ
authors.lastname: Mahapatra
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Baibaswata
authors.initials: B
authors.lastname: Nayak
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Harpreet
authors.initials: H
authors.lastname: Kaur
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. subratacharya@hotmail.com.
authors.forename: Subrat Kumar
authors.initials: SK
authors.lastname: Acharya
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D016751:Hepatitis E / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D016752:Hepatitis E virus; D006801:Humans; D007194:India / Q000453:epidemiology; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: ALF; Cerebral edema; Hepatitis A virus; Liver transplant; Prognosis