Hepatitis E virus in patients with acute severe liver injury

Table 1 Patient cohort

n	Gender		Age	ALT	Bilirubin	Creatinine	PT	WBC	Liver	Outcome
	Male	Female	mean ± SD	(10-50 IU/L)	(< 17 μmol/L)	(45-110 μmol/L)	(8-12 s)	(4.3-10.8 ×109 cells/L)	failure1
80	36 (45%)	44 (55%)	38.7 ± 14.1	5112 ± 3492	118 ± 96	181 ± 136	52 ± 34	9.96 ± 6.51	47 (58.8%)	SWOTX 54 (67.5%) SWTX 11 (18.3%) Died 15 (13.8%)

¹Defined as loss of hepatic cellular function and subsequent development of coagulopathy, jaundice and encephalopathy. Normal range indicated in brackets. ALT: Alanine aminotransferase; PT: Prothrombin time; WBC: White blood cell; SWOTX: Survived without transplant; SWTX: Survived with transplant.

Table 2 Prevalence of patient

Diagnosis	POD	Acute viral hepatitis	Autoimmune hepatitis	Post LTX graft nonfunction	Fatty liver of pregnancy	Malignancy	DILI	Acute porphyria	Ischaemic hepatitis
Prevalence	64 (80%)	61 (7.5%)	3 (3.75%)	2 (2.5%)	1 (1.25%)	1 (1.25%)	1 (1.25%)	1 (1.25%)	1 (1.25%)

¹The causes of acute viral hepatitis prior to retrospective testing were acute hepatitis B (n = 3), acute hepatitis C (n = 1), and acute hepatitis E (n = 1, case 4 who had travelled to India and was tested for hepatitis E virus at presentation). The diagnoses described are the diagnoses before retrospective testing for hepatitis E virus was undertaken. POD: Paracetamol overdose; LTX: Liver transplant; DILI: Drug induced liver injury.

Table 3 Hepatitis E virus immunoglobulin M positive patients

Patient ID	Gender	Age	Liver function tests (normal range)						HEV				Travel history	Initial/	Outcome
			ALT	Billirubin	ALP	Gamma GTP	Albumin	PT	IgG	IgM	RNA	Genotype		retrospective
			(10-50 IU/mL)	(< 17 μmol/L)	(40-125 IU/L)	(5-35 IU/mL)	(30-50 g/L)	(8-12 s)	(IU/mL)		(IU/mL)			diagnosis
1	Female	58	3648	92	540	480	35	16	48.4	+	6.4 × 104	3	Spain, Cornwall	DILI/hepatitis E	Survived
2	Female	67	98	516	256	Icteric1	19	14	36.49	+	1.4 × 103	3	Spain	Alcohol, T2Diabetes, obesity, CLD/hepatitis E	Died
3	Male	27	5288	140	186	368	27	35	24.7	+	-	-	London	POD/hepatitis E	Survived
4	Male	27	4044	269	253	Icteric1	38	25	42.05	+	1.9 × 104	1	India	Hepatitis E	Survived

¹GTP could not be calculated due to high serum bilirubin levels. Values obtained from serum samples taken on admission to SLTU. ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; GTP: Glutamyl transpeptidase; PT: Prothrombin time; HEV: Hepatitis E virus; Ig: Immunoglobulin; RNA: Ribonucleic acid; DILI: Drug induced liver injury; CLD: Chronic liver disease; POD: Paracetamol overdose.