Factors influencing the severity of acute viral hepatitis A
2
조회
0
다운로드
7
인용
0
참고문헌
키워드
초록
Background/Aims: Most patients with acute viral hepatitis A have a favorable course, but a few of them suffer from severe forms of hepatitis such as fulminant hepatitis. This study was carried out to identify the factors influencing the severity of acute viral hepatitis A. Methods: We retrospectively reviewed the medical records of 713 patients with acute hepatitis A, who were divided into two groups: severe hepatitis A (N=87) and non-severe hepatitis A (N=626). Severe hepatitis was defined as fulminant hepatitis or prolongation of prothrombin time (INR≥1.5). Clinical variables were compared between the two groups. Results: The incidence of fulminant hepatitis was 1.4 % (10/713) in patients with acute hepatitis A. Thirty-three (4.6 %) cases exhibited HBsAg positivity. In multivariate analyses, significant alcohol intake and the presence of HBsAg were significant predictive factors of fulminant hepatitis A, and significant alcohol intake and age were significant predictive factors of severe hepatitis A. HBeAg and HBV-DNA status did not affect the clinical course of hepatitis A in chronic hepatitis B carriers. Conclusions: While most patients with acute hepatitis A have an uncomplicated clinical course, our data suggest that a more-severe clinical course is correlated with being older, significant alcohol intake, and chronic hepatitis-B-virus infection.
Abstract
Background/Aims: Most patients with acute viral hepatitis A have a favorable course, but a few of them suffer from severe forms of hepatitis such as fulminant hepatitis. This study was carried out to identify the factors influencing the severity of acute viral hepatitis A. Methods: We retrospectively reviewed the medical records of 713 patients with acute hepatitis A, who were divided into two groups: severe hepatitis A (N=87) and non-severe hepatitis A (N=626). Severe hepatitis was defined as fulminant hepatitis or prolongation of prothrombin time (INR≥1.5). Clinical variables were compared between the two groups. Results: The incidence of fulminant hepatitis was 1.4 % (10/713) in patients with acute hepatitis A. Thirty-three (4.6 %) cases exhibited HBsAg positivity. In multivariate analyses, significant alcohol intake and the presence of HBsAg were significant predictive factors of fulminant hepatitis A, and significant alcohol intake and age were significant predictive factors of severe hepatitis A. HBeAg and HBV-DNA status did not affect the clinical course of hepatitis A in chronic hepatitis B carriers. Conclusions: While most patients with acute hepatitis A have an uncomplicated clinical course, our data suggest that a more-severe clinical course is correlated with being older, significant alcohol intake, and chronic hepatitis-B-virus infection.
참고문헌 (26)
- Hadler SC, "Hepatitis A in day-care centers. A community-wide assessment", N Engl J Med, 302, pp.1222~1227 (1980)
- Willner IR, "Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States", Ann Intern Med, 128, pp.111~114 (1998)
- Kim JY, "Seroepilemiology of Type A and Type B Hepatitis in Seoul Area", Korean J Intern Med, 25, pp.19~27 (1982)
- Yang DW, "A Seroepidemiologic Study on Hepatitis A in Seoul, Korea", J Korean Pediatr Soc, 42, pp.180~185 (1999)
- Laurence JC, "Hepatitis A and B immunizations of individuals infected with human immunodeficiency virus", Am J Med, 118, pp.75S~83S (2005)
- Fujiwara K, "Analysis of the genotype-determining region of hepatitis A viral RNA in relation to disease severities", Hepatol Res, 25, pp.124~134 (2003)
- Fujiwara K, "Phylogenetic analysis of hepatitis A virus in sera from patients with hepatitis A of various severities", Liver Int, 29, pp.838~845 (2009)
- Rezende G, "Viral and clinical factors associated with the fulminant course of hepatitis A infection", Hepatology, 38, pp.613~618 (2003)
- Vento S, "Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C", N Engl J Med, 338, pp.286~290 (1998)
- Coppola N, "Acute hepatitis with severe cholestasis and prolonged clinical course due to hepatitis A virus Ia and Ib coinfection", Clin Infect Dis, 44, pp.e73~77 (2007)
- Cuthbert JA, "Hepatitis A: old and new", Clin Microbiol Rev, 14, pp.38~58 (2001)
- Elinav E, "Acute hepatitis A infection in pregnancy is associated with high rates of gestational complications and preterm labor", Gastroenterology, 130, pp.1129~1134 (2006)
- Keeffe EB, "Is hepatitis A more severe in patients with chronic hepatitis B and other chronic liver diseases?", Am J Gastroenterol, 90, pp.201~205 (1995)
- Tassopoulos N, "1985", Liver, 5, pp.348~353
- Chu CM, "Increased incidence of fulminant hepatic failure in previously unrecognized HBsAg carriers with acute hepatitis independent of etiology", Infection, 33, pp.136~139 (2005)
- Pramoolsinsap C, "Acute hepatitis A and acquired immunity to hepatitis A virus in hepatitis B virus (HBV) carriers and in HBV- or hepatitis C virus-related chronic liver diseases in Thailand", J Viral Hepat, 7, pp.11~12 (2000)
- Corrao G, "Independent and combined action of hepatitis C virus infection and alcohol consumption on the risk of symptomatic liver cirrhosis", Hepatology, 27, pp.914~919 (1998)
- Polson J, "AASLD position paper: the management of acute liver failure", Hepatology, 41, pp.1179~1197 (2005)
- Weitz M, "Variation among hepatitis A virus strains. I. Genomic variation detected by T1 oligonucleotide mapping", Virus Res, pp.53~67 (1985)
- 김좌민, "전격성 A형간염의 임상양상 및 자발생존에 관한 예측인자", The Korean Journal of Hepatology, 14(4), pp.474~482 (2008), 대한간학회
- Schiodt FV, "Etiology and outcome for 295 patients with acute liver failure in the United States", Liver Transpl Surg, 5, pp.29~34 (1999)
- Lednar WM, "Frequency of illness associated with epidemic hepatitis A virus infections in adults", Am J Epidemiol, 122, pp.226~233 (1985)
- Brown GR, "Hepatitis A epidemic in the elderly", South Med J, 95, pp.826~833 (2002)
- Sjogren M, "Immunization and the decline of viral hepatitis as a cause of acute liver failure", Hepatology, 38, pp.554~556 (2003)
- Gao B, "Interaction of alcohol and hepatitis viral proteins: implication in synergistic effect of alcohol drinking and viral hepatitis on liver injury", Alcohol, 27, pp.69~72 (2002)