Investigation of underlying comorbidities as risk factors for symptomatic human hepatitis E virus infection

• Published in: Alimentary pharmacology & therapeutics Vol. 45; no. 5; pp. 701 - 713
• Main Authors: Zhang, S., Chen, C., Peng, J., Li, X., Zhang, D., Yan, J., Zhang, Y., Lu, C., Xun, J., Li, W., Ling, Y., Huang, Y., Chen, L.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.03.2017
• Subjects: Adult; Cirrhosis; Clinical outcomes; Comorbidity; Diabetes; Diabetes mellitus; Female; Geriatrics; Hepatitis; Hepatitis E - epidemiology; Hepatitis E virus - isolation & purification; Humans; Infections; Kidney transplantation; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - epidemiology; Liver diseases; Liver Failure - epidemiology; Logistic Models; Lung diseases; Male; Middle Aged; Mortality; Regression analysis; Retrospective Studies; Risk Factors; Tumors
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13938

Summary Background Symptomatic Hepatitis E virus (HEV) infection occurs in few infected subjects, and the risk factors are not completely known. Aim To explore the risk factors for adverse clinical outcomes in acute HEV infections. Methods 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. Results 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%). Conclusions 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. Linked ContentThis article is linked to Borentain and Colson et al papers. To view this article visit https://doi.org/10.1111/apt.14188.