Digestive center for diagnosis and treatment, Damascus, Syrian Arab Republic.
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Liver Int. 2018 Nov;38(11):1965-1973. doi: 10.1111/liv.13861. Epub 2018 May 25.
BACKGROUND & AIMS: Acute liver failure caused by hepatitis E virus genotype 3 and 4 has been rarely described. Because of the presence of a short golden therapeutic window in patients with viral acute liver failure from other causes, it is possible that early recognition and treatment might reduce the morbidity and mortality. We performed a systematic review and pooled analysis of acute liver failure caused by hepatitis E virus genotype 3 and 4.
Two reviewers appraised studies after searching multiple databases on June 12th, 2017. Appropriate tests were used to compare hepatitis E virus genotype 3 vs 4, suspected vs confirmed genotypes, hepatitis E virus-RNA positive vs negative, and to discern important mortality risk factors.
We identified 65 patients, with median age 58 years (range: 3-79), and a male to female ratio of 1.2:1. The median bilirubin, ALT, AST and alkaline phosphatase (expressed by multiplication of the upper limit of normal) levels were 14.8, 45.3, 34.8 and 1.63 respectively. Antihepatitis E virus IgG, antihepatitis E virus IgM and hepatitis E virus-RNA were positive in 84%, 91% and 86% of patients respectively. The median interval from symptoms onset to acute liver failure was 23 days, and 16 patients underwent liver transplantation. Final outcome was reported in 58 patients and mortality was 46%. Age was a predictor of poor prognosis in multivariate analysis. No important differences were found between patients infected with genotype 3 vs 4, patients with confirmed vs suspected genotypes, or patients with positive vs negative RNA.
Acute liver failure caused by hepatitis E virus genotype 3 and 4 is rare, similar between genotypes, occurs commonly in middle-aged/elderly patients and has a very high mortality. Age is predictive of poor prognosis in multivariate analysis.
由戊型肝炎病毒（HEV）基因型 3 和 4 引起的急性肝衰竭很少见。由于其他原因引起的病毒性急性肝衰竭患者存在短暂的治疗黄金窗口期，因此早期识别和治疗可能会降低发病率和死亡率。我们对由 HEV 基因型 3 和 4 引起的急性肝衰竭进行了系统评价和汇总分析。
两名审查员于 2017 年 6 月 12 日在多个数据库中搜索后评估了研究。使用适当的检验比较了 HEV 基因型 3 与 4、疑似与确诊基因型、HEV-RNA 阳性与阴性，并辨别了重要的死亡率危险因素。
我们确定了 65 例患者，中位年龄为 58 岁（范围：3-79），男女比例为 1.2:1。中位胆红素、ALT、AST 和碱性磷酸酶（用正常值上限的倍数表示）水平分别为 14.8、45.3、34.8 和 1.63。84%、91%和 86%的患者抗 HEV IgG、抗 HEV IgM 和 HEV-RNA 阳性。从症状发作到急性肝衰竭的中位时间间隔为 23 天，16 例患者进行了肝移植。58 例患者报告了最终结局，死亡率为 46%。多变量分析显示年龄是预后不良的预测因素。在基因型 3 与 4、确诊与疑似基因型或 RNA 阳性与阴性患者之间未发现重要差异。
由 HEV 基因型 3 和 4 引起的急性肝衰竭罕见，各基因型之间无明显差异，常见于中/老年患者，死亡率非常高。年龄是多变量分析中预后不良的预测因素。
