Fulminant hepatitis A virus infection in the United States

Incidence, prognosis, and outcomes

Ryan M. Taylor, Timothy Davern, Santiago Munoz, Stephen Huy Han, Brendan McGuire, Anne M. Larson, Linda Hynan, William M. Lee, Robert J. Fontana

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Acute liver failure (ALF) due to hepatitis A virus (HAV) infection is an uncommon but potentially lethal illness. The aim of this study was to identify readily available laboratory and clinical features associated with a poor prognosis among ALF patients with HAV infection. The presenting features of 29 adults with anti-HAV IgM positive ALF enrolled in the ALFSG_between 1998 and 2005 were reviewed. The HAV patients listed for transplantation by UNOS were also reviewed. Acute HAV accounted for 3.1% of patients enrolled in the ALFSG. At 3 weeks follow-up, 16 had spontaneously recovered (55%), 9 underwent transplantation (31%), and 4 had died (14%). A prognostic model incorporating 4 presenting features (serum ALT <2,600 IU/L, creatinine >2.0 mg/dL, intubation, pressors) had an AUROC for transplant/death of 0.899 which was significantly better than the King's College criteria (0.623, P = .018) and MELD scores (0.707, P = .0503). Between 1988 and 2005, the frequency of patients requiring liver transplantation for HAV in the UNOS database significantly decreased from 0.7% to 0.1% (P < .001). In addition, the proportion of HAV cases enrolled in the ALFSG significantly decreased from 5% to 0.8% (P = .007). In conclusion, the frequency of HAV patients enrolling in the ALFSG and being listed for liver transplantation in the United States has declined in parallel. A prognostic index consisting of 4 clinical and laboratory features predicted the likelihood of transplant/death significantly better than other published models suggesting that disease specific prognostic models may be of value in non-acetaminophen ALF.

Original languageEnglish (US)
Pages (from-to)1589-1597
Number of pages9
JournalHepatology
Volume44
Issue number6
DOIs
StatePublished - Dec 2006

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Hepatitis A virus
Virus Diseases
Acute Liver Failure
Incidence
Liver Transplantation
Transplantation
Transplants
Intubation
Immunoglobulin M
Databases

ASJC Scopus subject areas

  • Hepatology

Cite this

Taylor, R. M., Davern, T., Munoz, S., Han, S. H., McGuire, B., Larson, A. M., ... Fontana, R. J. (2006). Fulminant hepatitis A virus infection in the United States: Incidence, prognosis, and outcomes. Hepatology, 44(6), 1589-1597. https://doi.org/10.1002/hep.21439

Fulminant hepatitis A virus infection in the United States : Incidence, prognosis, and outcomes. / Taylor, Ryan M.; Davern, Timothy; Munoz, Santiago; Han, Stephen Huy; McGuire, Brendan; Larson, Anne M.; Hynan, Linda; Lee, William M.; Fontana, Robert J.

In: Hepatology, Vol. 44, No. 6, 12.2006, p. 1589-1597.

Research output: Contribution to journalArticle

Taylor, RM, Davern, T, Munoz, S, Han, SH, McGuire, B, Larson, AM, Hynan, L, Lee, WM & Fontana, RJ 2006, 'Fulminant hepatitis A virus infection in the United States: Incidence, prognosis, and outcomes', Hepatology, vol. 44, no. 6, pp. 1589-1597. https://doi.org/10.1002/hep.21439
Taylor RM, Davern T, Munoz S, Han SH, McGuire B, Larson AM et al. Fulminant hepatitis A virus infection in the United States: Incidence, prognosis, and outcomes. Hepatology. 2006 Dec;44(6):1589-1597. https://doi.org/10.1002/hep.21439
Taylor, Ryan M. ; Davern, Timothy ; Munoz, Santiago ; Han, Stephen Huy ; McGuire, Brendan ; Larson, Anne M. ; Hynan, Linda ; Lee, William M. ; Fontana, Robert J. / Fulminant hepatitis A virus infection in the United States : Incidence, prognosis, and outcomes. In: Hepatology. 2006 ; Vol. 44, No. 6. pp. 1589-1597.
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