University of Florida College of Medicine, Gainesville, Florida, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA.
J Viral Hepat. 2024 Nov;31(11):710-719. doi: 10.1111/jvh.13994. Epub 2024 Aug 11.
Hepatitis E virus (HEV) is typically asymptomatic in developed countries but can be more severe in certain populations. We aim to describe the epidemiology of HEV-associated hospitalisations from 1998 to 2020 in the United States, investigate risk factors for inpatient mortality and describe outcomes in pregnant women. We utilised the National Inpatient Sample and extracted cases of HEV-associated hospitalisations using ICD-9/10 diagnostic codes. Demographic, clinical and pregnancy data were extracted and analysed by chi-square and logistic regression. We identified 3354 cases of HEV-associated hospitalisations; 1689 (50.4%) were female and 1425 (42.5%) were non-Hispanic White. The median age was 50 (IQR: 37-59) years. Hospitalisation rates for HEV ranged from 2.5 per 10,000,000 in 2008 to a peak of 9.6 per 10,000,000 people in the general U.S. population in 2004. The mortality rate was 5.2%. Age ≥ 40 years (OR: 7.73; 95% CI: 1.57-38.09; p = 0.012), HIV infection (OR: 4.63; 95% CI: 1.26-16.97; p = 0.021), and coagulopathy (OR: 7.22; 95% CI: 2.81-18.57; p < 0.001) were associated with increased odds of mortality within the HEV cohort. There were 226 pregnant women with HEV. Rates of maternal death, stillbirth and preterm birth were similar between HEV and non-HEV pregnant cohorts. Hepatitis B and hepatitis C co-infection were significantly more common in the HEV pregnant cohort (p < 0.05). HEV-associated hospitalisations are uncommon in the United States, but likely underdiagnosed. Certain risk factors can be used to predict prognosis of these hospitalised patients. Pregnant women with HEV appear to have favourable maternal and fetal outcomes despite hepatitis B and C co-infection.
戊型肝炎病毒（HEV）在发达国家通常无症状，但在某些人群中可能更为严重。我们旨在描述 1998 年至 2020 年美国 HEV 相关住院治疗的流行病学，调查住院死亡率的危险因素，并描述孕妇的结局。我们利用国家住院患者样本，并使用 ICD-9/10 诊断代码提取 HEV 相关住院治疗的病例。提取人口统计学、临床和妊娠数据，并通过卡方检验和逻辑回归进行分析。我们确定了 3354 例 HEV 相关住院治疗病例；1689 例（50.4%）为女性，1425 例（42.5%）为非西班牙裔白人。中位年龄为 50（IQR：37-59）岁。HEV 的住院率范围为每 1000 万人中有 2.5 例，在普通美国人群中于 2004 年达到每 1000 万人中有 9.6 例的峰值。死亡率为 5.2%。年龄≥40 岁（OR：7.73；95%CI：1.57-38.09；p=0.012）、HIV 感染（OR：4.63；95%CI：1.26-16.97；p=0.021）和凝血障碍（OR：7.22；95%CI：2.81-18.57；p<0.001）与 HEV 队列中的死亡率增加相关。有 226 例孕妇患有 HEV。HEV 和非 HEV 孕妇队列的孕产妇死亡率、死产率和早产率相似。乙型肝炎和丙型肝炎合并感染在 HEV 孕妇队列中明显更为常见（p<0.05）。美国 HEV 相关住院治疗并不常见，但可能诊断不足。某些危险因素可用于预测这些住院患者的预后。尽管乙型肝炎和丙型肝炎合并感染，患有 HEV 的孕妇似乎有良好的母婴结局。
