Shanghai Public Health Clinical center, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
Key Laboratory of Medical Molecular Virology of Ministries of Education/Health, Institute of Medical Microbiology, Shanghai Medical College of Fudan University, Shanghai, China.
Aliment Pharmacol Ther. 2017 Mar;45(5):701-713. doi: 10.1111/apt.13938. Epub 2017 Jan 12.
Symptomatic Hepatitis E virus (HEV) infection occurs in few infected subjects, and the risk factors are not completely known.
To explore the risk factors for adverse clinical outcomes in acute HEV infections.
A large retrospective study was conducted. The baseline characteristics, clinical outcomes, and laboratory data of 512 acute HEV infection cases were analysed using logistic regression models.
All patients exhibited autochthonous sporadic HEV infections, and most were elderly. Their symptoms varied from asymptomatic to severe liver diseases. In all, 215 patients (42.0%) had liver failure and/or decompensation, and 45 (8.2%) patients died within 3 months. Nearly 60% of patients had underlying chronic liver diseases (CLDs), 20% were cirrhotic, and various extrahepatic underlying comorbidities were common. The logistic regression analysis revealed that underlying CLDs, especially cirrhosis, were closely associated with disease severity (OR = 8.78, P < 0.001) but not with mortality in patients with severe liver diseases. In addition to the known factors, including an old age, the male gender and CLDs, we identified pre-existing extrahepatic tumours, diabetes, and chronic respiratory and renal diseases as novel independent predictors for adverse clinical outcomes. Importantly, patients without these four extrahepatic comorbidities showed a much lower mortality rate (4.2%, P < 0.001) than patients with one (18.5%) or more comorbidities (34.5%).
Previous comorbidities, including tumours, diabetes, and chronic liver, lung and kidney diseases, were independent risk factors for adverse outcomes, especially mortality, in acute HEV infections. This study provides valuable data for improving the prevention and control of HEV infection.
有症状的戊型肝炎病毒 (HEV) 感染在少数感染患者中发生，其危险因素尚不完全清楚。
探讨急性 HEV 感染不良临床结局的危险因素。
进行了一项大型回顾性研究。使用逻辑回归模型分析了 512 例急性 HEV 感染病例的基线特征、临床结局和实验室数据。
所有患者均为自发性散发性 HEV 感染，且以老年人为主。其症状从无症状到严重肝脏疾病不等。共有 215 例（42.0%）患者发生肝衰竭和/或失代偿，45 例（8.2%）患者在 3 个月内死亡。近 60%的患者存在慢性肝脏疾病（CLD），20%为肝硬化，各种肝外合并症较为常见。逻辑回归分析显示，基础 CLD，特别是肝硬化，与疾病严重程度密切相关（OR=8.78，P<0.001），但与严重肝脏疾病患者的死亡率无关。除了已知的因素，包括年龄较大、男性和 CLD 外，我们还发现先前存在的肝外肿瘤、糖尿病和慢性呼吸及肾脏疾病是不良临床结局的新的独立预测因素。重要的是，没有这四种肝外合并症的患者死亡率明显低于有一个（18.5%）或更多合并症（34.5%）的患者（4.2%，P<0.001）。
先前存在的合并症，包括肿瘤、糖尿病和慢性肝、肺及肾脏疾病，是急性 HEV 感染不良结局，特别是死亡的独立危险因素。本研究为改善 HEV 感染的预防和控制提供了有价值的数据。
