Korean J Gastroenterol.  2014 Jan;63(1):25-31. 10.4166/kjg.2014.63.1.25.

Clinical Features and Risk Factors for Severe Complications among Patients with Acute Hepatitis A Virus Infection in The Jeonbuk Province of Korea

• Yoo SH
• Kim IH
• Jang JW
• Choi CH
• Moon JC
• Park JK
• Lee SY
• Kim SH
• Kim SW
• Lee SO
• Lee ST
• Kim DG
• Cho EY
• Jung GM

• KMID: 1711302
• DOI: http://doi.org/10.4166/kjg.2014.63.1.25

Abstract

BACKGROUND/AIMS
The frequency of symptomatic acute HAV infections in adulthood are increasing in Korea. This study analyzes the clinical severity in patients with acute HAV infection and investigates risk factors associated with three severe complications: prolonged cholestasis, acute kidney injury, and acute liver failure.
METHODS
We performed a retrospective analysis of 726 patients diagnosed from January 2006 to December 2010 at three tertiary hospitals in Jeonbuk Province, Republic of Korea with acute HAV infection.
RESULTS
In the group of 726 patients, the mean age was 30.3 years, 426 (58.6%) were male, and 34 (4.7%) were HBsAg positive. Severe complications from acute HAV infection occurred as follows: prolonged cholestasis in 33 (4.6%), acute kidney injury in 17 (2.3%), and acute liver failure in 16 (2.2%). Through multivariate analysis, age > or =40 years (OR 2.63, p=0.024) and peak PT (INR) > or =1.5 (OR 5.81, p=0.035) were found to be significant risk factors for prolonged cholestasis. Age > or =40 years (OR 5.24, p=0.002) and female gender (OR 3.11, p=0.036) were significant risk factors for acute kidney injury. Age > or =40 years (OR 6.91, p=0.002), HBsAg positivity (OR 5.02, p=0.049), and peak total bilirubin (OR 1.11, p=0.001) were significant risk factors for acute liver failure.
CONCLUSIONS
Age > or =40 years, female gender, HBsAg positivity, peak PT (INR) > or =1.5, and peak total bilirubin were significant risk factors for severe complications in acute HAV infections.

Keyword

Hepatitis A; Cholestasis; Acute kidney injuries; Acute liver failure; Risk

MeSH Terms

Acute Disease
Acute Kidney Injury/complications
Adult
Cholestasis/complications
Female
Hepatitis A/complications/*diagnosis
Hepatitis B Surface Antigens/blood
Humans
Liver Failure, Acute/complications
Male
Middle Aged
Odds Ratio
Republic of Korea
Retrospective Studies
Risk Factors
Tertiary Care Centers
Hepatitis B Surface Antigens

Reference

References

1. Jeong SH, Lee HS. Hepatitis A: clinical manifestations and management. Intervirology. 2010; 53:15–19.

2. Lee H, Cho HK, Kim JH, Kim KH. Seroepidemiology of hepatitis A in Korea: changes over the past 30 years. J Korean Med Sci. 2011; 26:791–796.

3. Lee D, Cho YA, Park Y, et al. Hepatitis a in Korea: epidemiological shift and call for vaccine strategy. Intervirology. 2008; 51:70–74.

4. Lee D, Ki M, Lee A, et al. A nationwide seroprevalence of total antibody to hepatitis A virus from 2005 to 2009: age and area-ad-justed prevalence rates. Korean J Hepatol. 2011; 17:44–50.

5. Kang HM, Jeong SH, Kim JW, et al. Recent etiology and clinical features of acute viral hepatitis in a single center of Korea. Korean J Hepatol. 2007; 13:495–502.

6. Lee SS, Byoun YS, Jeong SH, et al. Type and cause of liver disease in Korea: single-center experience, 2005–2010. Clin Mol Hepatol. 2012; 18:309–315.

7. Lee TH, Kim SM, Lee GS, et al. Clinical features of acute hepatitis A in the Western part of Daejeon and Chungnam province: single center experience. Korean J Gastroenterol. 2006; 47:136–143.

8. Kim JI, Kim YS, Jung YK, et al. Factors influencing the severity of acute viral hepatitis A. Korean J Hepatol. 2010; 16:295–300.

9. Ajmera V, Xia G, Vaughan G, et al. Acute Liver Failure Study Group. What factors determine the severity of hepatitis A-related acute liver failure? J Viral Hepat. 2011; 18:e167–e174.

10. Jung YM, Park SJ, Kim JS, et al. Atypical manifestations of hepatitis A infection: a prospective, multicenter study in Korea. J Med Virol. 2010; 82:1318–1326.

11. Choi HK, Song YG, Han SH, et al. Clinical features and outcomes of acute kidney injury among patients with acute hepatitis A. J Clin Virol. 2011; 52:192–197.

12. Polson J, Lee WM. American Association for the Study of Liver Disease. AASLD position paper: the management of acute liver failure. Hepatology. 2005; 41:1179–1197.

13. Park HS, Choi BY, Kwon YD. Rapid increase in the national treatment costs for hepatitis A infections in Korea. Tohoku J Exp Med. 2011; 226:85–93.

14. Kim DY, Kim IH, Jeong SH, et al. A nationwide seroepidemiology of hepatitis C virus infection in South Korea. Liver Int. 2013; 33:586–594.

15. Cho HC, Paik SW, Kim YJ, et al. Seroprevalence of anti-HAV among patients with chronic viral liver disease. World J Gastroenterol. 2011; 17:236–241.

16. Almasio PL, Amoroso P. HAV infection in chronic liver disease: a rationale for vaccination. Vaccine. 2003; 21:2238–2241.

17. Chu CM, Liaw YF. Increased incidence of fulminant hepatic failure in previously unrecognized HBsAg carriers with acute hepatitis independent of etiology. Infection. 2005; 33:136–139.

18. Kim KM, Eo SJ, Gwak GY, et al. Comparison of the clinical features of hepatitis A between HBsAg-positive and HBsAg-negative patients. Gut Liver. 2011; 5:500–505.

19. Vento S, Garofano T, Renzini C, et al. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med. 1998; 338:286–290.

20. Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med. 1998; 128:111–114.

21. Rezende G, Roque-Afonso AM, Samuel D, et al. Viral and clinical factors associated with the fulminant course of hepatitis A infection. Hepatology. 2003; 38:613–618.

22. Kim JH, Yeon JE, Baik SK, et al. Genotypic shift of the hepatitis A virus and its clinical impact on acute hepatitis A in Korea: a nationwide multicenter study. Scand J Infect Dis. 2013; 45:811–818.