TY - JOUR
T1 - Role of Hepatitis C Infection in Acute Liver Injury/Acute Liver Failure in North America
AU - Rao, Ashwin
AU - Rule, Jody A.
AU - Cerro-Chiang, Giuliana
AU - Stravitz, Richard T.
AU - McGuire, Brendan M.
AU - Lee, Goo
AU - Fontana, Robert J.
AU - Lee, William M.
N1 - Funding Information:
This work was supported by NIDDK (Grant No. U-01 58369).
Funding Information:
The Acute Liver Failure Study Group (ALFSG) is a multi-center consortium of 23 sites, funded by the National Institute of Diabetes and Digestive and Kidney Diseases with an aim of elucidating the causes, clinical features, and outcomes of adult patients with ALF and Acute Liver injury (ALI). Between January 1998 and January 2017, 2332 adult patients meeting entry criteria for ALF and 667 adult patients meeting entry criteria for ALI were enrolled []. ALF was defined as coagulopathy (INR ≥ 1.5), any degree of hepatic encephalopathy, and an illness of ≤ 26 weeks’ duration in patients without known chronic liver disease []. ALI was defined as an INR ≥ 2, absence of hepatic encephalopathy, and an illness of ≤ 26 weeks’ duration in patients without known chronic liver disease []. Comprehensive demographic, clinical, and laboratory values were recorded prospectively at enrollment and serially for 7 days. Outcomes at 21 days post-enrollment were classified as transplant-free survival, liver transplantation, or death. A written informed consent was obtained from enrolled subjects if not encephalopathic or from legally authorized representative if impaired mentation was present. Each center’s Institutional Review Board approved the study, centers abided by the Health Insurance Portability and Accountability Act (HIPAA), and the study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2023/1
Y1 - 2023/1
N2 - Background: While hepatitis A and B are well-known causes of acute liver failure (ALF), few well-documented cases of hepatitis C virus (HCV) infection (absent preexisting liver disease or other liver insults) have been described that result in ALF. We reviewed the Acute Liver Failure Study Group registry for evidence of HCV as a primary or contributing cause to ALF. Methods: From January 1998 to January 2017, 2,332 patients with ALF (INR ≥ 1.5, any degree of hepatic encephalopathy) and 667 with acute liver injury (ALI; INR ≥ 2.0, no hepatic encephalopathy) were enrolled. Anti-HCV testing was done routinely, with confirmatory RT-PCR testing for HCV RNA where necessary. Results: A total of 136 patients were anti-HCV-antibody positive, as follows: 56 HCV RNA negative, 65 HCV RNA positive, and 8 with no result nor sera available for testing. Only three subjects with ALI/ALF were determined to represent acute HCV infection. Case 1: 47-year-old female with morbid obesity (BMI 52.4) developed ALF and recovered, experiencing anti-HCV seroconversion. Case 2: 37-year-old female using cocaine presented with ALI and fully recovered. Case 3: 54-year-old female developed ALF requiring transplantation and was anti-HCV negative but viremic prior to transplant experiencing anti-HCV seroconversion thereafter. Among 1636 APAP overdose patients, the 52 with concomitant chronic HCV had higher 3-week mortality than the 1584 without HCV (31% vs 17%, p = 0.01). Conclusions: ALI/ALF solely related to acute hepatitis C infection is very rare. Chronic HCV infection, found in at least 65 (2.2%) of ALI/ALF patients studied, contributed to more severe outcomes in APAP ALI/ALF; ClinicalTrials.gov number, NCT000518440. Trial Registration ClinicalTrials.gov number NCT000518440.
AB - Background: While hepatitis A and B are well-known causes of acute liver failure (ALF), few well-documented cases of hepatitis C virus (HCV) infection (absent preexisting liver disease or other liver insults) have been described that result in ALF. We reviewed the Acute Liver Failure Study Group registry for evidence of HCV as a primary or contributing cause to ALF. Methods: From January 1998 to January 2017, 2,332 patients with ALF (INR ≥ 1.5, any degree of hepatic encephalopathy) and 667 with acute liver injury (ALI; INR ≥ 2.0, no hepatic encephalopathy) were enrolled. Anti-HCV testing was done routinely, with confirmatory RT-PCR testing for HCV RNA where necessary. Results: A total of 136 patients were anti-HCV-antibody positive, as follows: 56 HCV RNA negative, 65 HCV RNA positive, and 8 with no result nor sera available for testing. Only three subjects with ALI/ALF were determined to represent acute HCV infection. Case 1: 47-year-old female with morbid obesity (BMI 52.4) developed ALF and recovered, experiencing anti-HCV seroconversion. Case 2: 37-year-old female using cocaine presented with ALI and fully recovered. Case 3: 54-year-old female developed ALF requiring transplantation and was anti-HCV negative but viremic prior to transplant experiencing anti-HCV seroconversion thereafter. Among 1636 APAP overdose patients, the 52 with concomitant chronic HCV had higher 3-week mortality than the 1584 without HCV (31% vs 17%, p = 0.01). Conclusions: ALI/ALF solely related to acute hepatitis C infection is very rare. Chronic HCV infection, found in at least 65 (2.2%) of ALI/ALF patients studied, contributed to more severe outcomes in APAP ALI/ALF; ClinicalTrials.gov number, NCT000518440. Trial Registration ClinicalTrials.gov number NCT000518440.
KW - Fulminant hepatic failure
KW - Liver transplantation
KW - Viral hepatitis
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U2 - 10.1007/s10620-022-07524-6
DO - 10.1007/s10620-022-07524-6
M3 - Article
C2 - 35546205
AN - SCOPUS:85129840671
SN - 0163-2116
VL - 68
SP - 304
EP - 311
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 1
ER -