Acute liver failure due to Hepatitis A virus infection is an uncommon but potentially lethal illness.
Dr Robert Fontana and colleagues from Michigan identified laboratory and clinical features associated with a poor prognosis among acute liver failure patients with Hepatitis A virus infection.
The presenting features of 29 adults with anti-hepatitis A virus immunoglobulin M positive acute liver failure were reviewed.
The identified adults were enrolled in the United States Acute Liver Failure Study Group between 1998 and 2005.
The research team analyzed Hepatitis A virus patients listed for transplantation by United Network for Organ Sharing.
Acute Hepatitis A virus accounted for 3% of patients enrolled in the United States Acute Liver Failure Study Group.
|Hepatitis A cases decreased from 5% to less than 1%|
At 3 weeks follow-up, 55% had spontaneously recovered, 31% underwent transplantation, and 14% had died.
The team used a prognostic model incorporating 4 presenting features, which had an area under the receiver operating curve for transplant or death of 0.9.
The researchers found that this model was significantly better than the King's College criteria, and Model for End-Stage Liver Disease scores.
Between 1988 and 2005, patients requiring liver transplants for Hepatitis A in the United Network for Organ Sharing database decreased from 0.7 % to 0.1%.
In addition, the team noted that Hepatitis A virus cases enrolled in the United States Acute Liver Failure Study Group decreased from 5% to less than 1%.
Dr Fontana's team concludes, “The frequency of Hepatitis A virus patients enrolling in the United States Acute Liver Failure Study Group and being listed for liver transplantation in the United States has declined in parallel.”
“A prognostic index consisting of 4 clinical and laboratory features predicted the likelihood of transplant/death significantly better than other published models.”
“This suggests that disease specific prognostic models may be of value in non-acetaminophen acute liver failure.”