Original articlePancreas, biliary tract, and liverHepatitis E Virus Infection as a Possible Cause of Acute Liver Failure in Europe
Section snippets
Patient Identification
The study was performed according to the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice Guideline. In a retrospective monocenter study (November 2006 to December 2013), 80 patients were recruited with a diagnosis of ALF. Patients were excluded if they did not meet the criteria defined by the Acute Liver Failure Study Group Germany.11 In brief, ALF was diagnosed by significant liver dysfunction with pathologically increased laboratory parameters
Demographic and Clinical Features
Eighty patients had severe ALF according to the Acute Liver Failure Study Group Germany definition. The median age of all ALF patients was 41 years. Forty-nine patients (61%) were female. The most prevalent etiology was drug-induced liver failure (38%), including acetaminophen-induced liver failure and idiosyncratic drug-induced liver injury (DILI), followed by viral hepatitis (hepatitis A and B). These numbers are consistent with previous studies in Germany and other parts of Europe.11, 15
Discussion
In Europe, hepatitis E has been regarded as an imported infection from endemic regions. Recently, the rate of new HEV infections in Europe has increased,5 and currently in Western countries the impact of hepatitis E for nontraveling, immunocompetent persons is underestimated.16, 17
Our study suggests that hepatitis E contributes to a substantial proportion of acute liver injury cases in developed countries.12, 18 In our cohort, 8 of 80 ALF cases were detected to be potentially hepatitis
References (35)
- et al.
Hepatitis E: an emerging infection in developed countries
Lancet Infect Dis
(2008) - et al.
Etiologies and outcomes of acute liver failure in Germany
Clin Gastroenterol Hepatol
(2012) - et al.
Detection of hepatitis E virus (HEV) from porcine livers in Southeastern Germany and high sequence homology to human HEV isolates
J Clin Virol
(2011) - et al.
Lessons from look-back in acute liver failure? A single centre experience of 3300 patients
J Hepatol
(2013) - et al.
Frequent hepatitis E in the Netherlands without traveling or immunosuppression
J Clin Virol
(2015) - et al.
Hepatitis E antibody seroconversion without disease in highly endemic rural Egyptian communities
Trans R Soc Trop Med Hyg
(2006) - et al.
Low risk of hepatitis E virus reactivation after haematopoietic stem cell transplantation
J Clin Virol
(2012) - et al.
Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation
J Hepatol
(2007) - et al.
Acute liver failure
N Engl J Med
(2013) - et al.
Hepatitis E virus seroprevalence among adults
Germany. Emerg Infect Dis
(2012)
Hepatitis E in high-income countries
Curr Opin Infect Dis
Test performance characteristics of anti-HEV IgG assays strongly influence hepatitis E seroprevalence estimates
J Infect Dis
Transmission routes and risk factors for autochthonous hepatitis E virus infection in Europe: a systematic review
Epidemiol Infect
MELD score: utility and comparison with King’s College criteria in non-acetaminophen acute liver failure
J Coll Physicians Surg Pak
Acute hepatic failure in India: a perspective from the East
J Gastroenterol Hepatol
The role of hepatitis E virus infection in adult American patients with acute liver failure
Hepatology
Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988-1994
J Infect Dis
Cited by (77)
Viral hepatitis E: Clinical manifestations, treatment, and prevention
2024, Liver ResearchLiver Transplantation for Acute Liver Failure- Indication, Prioritization, Timing, and Referral
2023, Journal of Clinical and Experimental HepatologyHepatitis A and E in the Mediterranean: A systematic review
2022, Travel Medicine and Infectious DiseasePerformance of Roche qualitative HEV assay on the cobas 6800 platform for quantitative measurement of HEV RNA
2020, Journal of Clinical VirologyCitation Excerpt :Recent data demonstrate that HEV infection is the most common cause of acute viral hepatitis in many countries, including Germany [3,4]. The infection may be asymptomatic, cause acute hepatitis without further complications or even trigger an acute liver failure especially in patients with underlying liver injury [5]. Furthermore, HEV infection can take chronic courses in immunosuppressed patients, which, remaining untreated, could lead to liver cirrhosis [6–8].
Acute Liver Failure Guidelines
2023, American Journal of Gastroenterology
This article has an accompanying continuing medical education activity on page e158. Learning Objective–Upon completion of this activity, successful learners will be able to diagnose possible cases of hepatitis E virus associated liver failure.
Conflicts of interest The authors disclose no conflicts.
Funding Supported by the Deutsche Forschungsgemeinschaft (267/11-1 and 267/13-1 to A.C.) and by the Wilhelm-Laupitz Foundation to AC.