Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 28, 2012; 18(48): 7279-7284
Published online Dec 28, 2012. doi: 10.3748/wjg.v18.i48.7279
Clinical features and risk factors of acute hepatitis E with severe jaundice
Bin Xu, Hai-Bin Yu, Wei Hui, Jia-Li He, Lin-Lin Wei, Zheng Wang, Xin-Hui Guo
Bin Xu, Hai-Bin Yu, Wei Hui, Jia-Li He, Lin-Lin Wei, Zheng Wang, Xin-Hui Guo, Liver and Endocrine DiseasesWard of Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Author contributions: Xu B and Yu HB contributed equally to this work; Xu B drafted and approved the manuscript; Hui W, He JL, Wei LL, Wang Z and Guo XH participated in the design and coordination of the study and performed the literatures analysis; and all authors read and approved the final manuscript.
Supported by Basic and Clinical Research of Capital Medical University, No. 2010JL10, to Xu B
Correspondence to: Dr. Bin Xu, MD, PhD, Liver and Endocrine Diseases Ward of Beijing Youan Hospital, Capital Medical University, Beijing 100069, China. xubin1016@yahoo.cn
Telephone: +86-10-83997129 Fax: +86-10-63296483
Received: August 24, 2012
Revised: November 16, 2012
Accepted: November 24, 2012
Published online: December 28, 2012
Abstract

AIM: To compares the clinical features of patients infected with hepatitis E virus (HEV) with or without severe jaundice. In addition, the risk factors for HEV infection with severe jaundice were investigated.

METHODS: We enrolled 235 patients with HEV into a cross-sectional study using multi-stage sampling to select the study group. Patients with possible acute hepatitis E showing elevated liver enzyme levels were screened for HEV infection using serologic and molecular tools.HEV infection was documented by HEV antibodies and by the detection of HEV-RNA in serum. We used χ2 analysis, Fisher’s exact test, and Student’s t test where appropriate in this study. Significant predictors in the univariate analysis were then included in a forward, stepwise multiple logistic regression model.

RESULTS: No significant differences in symptoms, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or hepatitis B virus surface antigen between the two groups were observed. HEV infected patients with severe jaundice had significantly lower peak serum levels of γ-glutamyl-transpeptidase (GGT) (median: 170.31 U/L vs 237.96 U/L, P = 0.007), significantly lower ALB levels (33.84 g/L vs 36.89 g/L, P = 0.000), significantly lower acetylcholine esterase (CHE) levels (4500.93 U/L vs 5815.28 U/L, P = 0.000) and significantly higher total bile acid (TBA) levels (275.56 μmol/L vs 147.03 μmol/L, P = 0.000) than those without severe jaundice. The median of the lowest point time tended to be lower in patients with severe jaundice (81.64% vs 96.12%, P = 0.000). HEV infected patients with severe jaundice had a significantly higher viral load (median: 134 vs 112, P = 0.025) than those without severe jaundice. HEV infected patients with severe jaundice showed a trend toward longer median hospital stay (38.17 d vs 18.36 d, P = 0.073). Multivariate logistic regression indicated that there were significant differences in age, sex, viral load, GGT, albumin, TBA, CHE, prothrombin index, alcohol overconsumption, and duration of admission between patients infected with acute hepatitis E with and without severe jaundice.

CONCLUSION: Acute hepatitis E patients may naturally present with severe jaundice.

Keywords: Hepatitis E virus, Acute hepatitis E, Clinical features, Severe jaundice, Risk factor