Effect of Acute Hepatitis E Infection in Patients with Liver Cirrhosis

Abstract

Introduction: Hepatitis E virus is a major cause of enterically transmitted hepatitis. Mortality is very
high if it is associated with pregnancy, especially during third trimester. This study was carried out to
fi nd out the effects of acute HEV hepatitis on Chronic Liver Disease patients of different etiologies.
Methods: The consecutive patients of liver cirrhosis with defi nite evidence of recent HEV infection
were enrolled in this study. Acute hepatitis was diagnosed by presence of prodromal symptoms
and anti-HEV IgM antibody in their serum. The outcomes after superinfection with HEV hepatitis
were determined by changes in Child Pugh score, recovery of liver function test, hospital stay and
mortality.
Results: After exclusion 25 were studied. The etiology of cirrhosis in patients was: alcohol 13,
autoimmune hepatitis 3, hepatitis B 2, Budd Chiari syndrome 2, alcohol plus hepatitis B 1, hepatitis C
1, cardiac cirrhosis 1, Wilson’s disease 1 and cryptogenic 1. All patients with no recent decompensation
showed signs of decompensation during admission. Seven (28%) patients died. The cause of death
was either upper gastrointestinal bleeding or hepatorenal syndrome. Remaining patients had
prolonged hospital stay with deterioration of Child-Pugh’s score.
Conclusions: Superinfection of HEV in cirrhotic patient causes rapid decompensation. The morbidity
and mortality is higher compared to those non-infected patients. Development of hepatorenal
syndrome and upper GI bleeding was commonest cause of death.
Key Words: acute HEV infection, Chronic liver disease, third trimester pregnancy