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

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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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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.",
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