Novel Tool May Predict Poor Outcomes Among Patients with Hepatitis A

Researchers have developed a novel tool that can identify which individuals with acute hepatitis A infection are at increased risk for poor outcomes, including infection and acute liver failure (ALF). The research was presented at Digestive Disease Week on Monday, May 20, in San Diego, California.

“There have been multiple hepatitis A outbreaks throughout the United States within the last few years with higher mortality rates than in the past,” the researchers wrote in the abstract. “Prompt identification of these patients may allow for triage to higher level of care, earlier antimicrobial therapy, or transfer to [a] transplant center.”

In the retrospective cohort study, the researchers evaluated 106 patients hospitalized at a tertiary care center in San Diego for acute hepatitis A infection between November 1, 2016, and October 10, 2017.

ALF was defined as a combination of an international normalized ratio greater than 1.5, the presence of hepatic encephalopathy, and acute liver injury.

Among the patients, 10.4% developed ALF and 6.6% died within 30 days of presentation. Bacteremia was observed in 63.6% of individuals with ALF compared with 2.1% without ALF.

Results of bivariate analysis showed that compared with those who did not develop ALF, individuals with acute hepatitis A infection who progressed to ALF were more likely to have had a history of alcohol abuse (39.1% vs 90.9%, respectively), a lower hemoglobin level (13.3 vs 11.7, respectively), a lower serum sodium level (134.6 vs 127.5), and a higher Maddrey discriminant function score (21.1 vs 63.9).

Multivariate analysis further showed that a higher initial Model of End-Stage Liver Disease (MELD-Na) score (odds ratio [OR], 1.2; 95% CI, 1.018-1.427) and a lower initial serum albumin level (OR, 9.35; 95% CI, 1.15-76.9) were associated with an increased likelihood of developing ALF.

The researchers developed a predictive model using both serum albumin levels and MELD-Na scores (SAM).

“SAM is a promising and novel tool to recognize patients with hepatitis A who are at high risk of developing ALF,” the researchers concluded.

—Melinda Stevens

Reference:

Greenwald HS, Jiang A, Sheikh L, Malhotra A, Sweeney DA. A novel tool for predicting liver failure in patients with acute hepatitis A infection. Presented at: Digestive Disease Week; May 18-21; San Diego, CA. https://www.gastrojournal.org/article/S0016-5085(19)39980-9/pdf?referrer=https%3A%2F%2Fwww.gastrojournal.org%2Farticle%2FS0016-5085%2819%2939980-9%2Ffulltext. Accessed May 20, 2019.