Jiang AA, Greenwald HS, Sheikh L, Wooten DA, Malhotra A, Schooley RT, Sweeney DA. Predictors of Acute Liver Failure in Patients With Acute Hepatitis A: An Analysis of the 2016-2018 San Diego County Hepatitis A Outbreak.
Open Forum Infect Dis 2019;
6:ofz467. [PMID:
31777757 PMCID:
PMC6868431 DOI:
10.1093/ofid/ofz467]
[Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/04/2019] [Indexed: 02/01/2023] Open
Abstract
Background
Between 2016 and 2018, San Diego County experienced a hepatitis A outbreak with a historically high mortality rate (3.4%) that highlighted the need for early recognition of those at risk of developing acute liver failure (ALF).
Methods
A retrospective case series of adult hospitalized patients with acute hepatitis A.
Results
One hundred six patients with hepatitis A were studied, of whom 11 (10.4%) developed ALF, of whom 7 (6.6%) died. A history of alcohol abuse, hyperbilirubinemia, hypoalbuminemia, hyponatremia, and anemia were associated with increased odds of developing ALF. Initial Maddrey’s and Model of End-Stage Liver Disease Sodium (MELD-Na) scores were also associated with the development of ALF. Multivariable analysis showed that a higher initial MELD-Na score (odds ratio [OR], 1.205; 95% confidence interval [CI], 1.018–1.427) and a lower initial serum albumin concentration (OR, 9.35; 95% CI, 1.15–76.9) were associated with increased odds of developing ALF. Combining serum albumin and MELD-Na (SAM; C-statistic, 0.8878; 95% CI, 0.756–0.988) yielded a model that was not better than either serum albumin (C-statistic, 0.852; 95% CI, 0.675–0.976) or MELD-Na (C-statistic, 0.891; 95% CI, 0.784–0.968; P = .841). Finally, positive blood cultures were more common among patients with ALF compared with those without ALF (63.6% vs 4.3%; P < .00001).
Conclusions
Hypoalbuminemia was associated with an increased risk of ALF in patients with acute hepatitis A. Positive blood cultures and septic shock as a cause of death were common among patients with ALF. Providers caring for patients with acute hepatitis A should monitor for early signs of sepsis and consider empiric antibiotics, especially in patients presenting with hypoalbuminemia.
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