Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: a multicentre retrospective study

Sebastian J. Wallace (Lead / Corresponding author), Rachael Swann, Mhairi Donnelly, Linda Kemp, Julia Guaci, Aimee Murray, Johannes Spoor, Nan Lin, Michael Miller, Harry R. Dalton, S. Hyder Hussaini, Rory Gunson, Kenneth Simpson, Adrian Stanley, Andrew Fraser

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Abstract

Background: Hepatitis E virus (HEV) is the most common acute viral hepatitis in Scotland. Little is known about the burden of morbidity and mortality, which can be high in chronic liver disease or immunocompromised states. Aims: To record the morbidity and mortality of HEV in Scotland. Methods: Demographic, clinical and laboratory data were collected retrospectively from all cases of HEV reported to virology departments across nine NHS health boards, between January 2013 and January 2018. Results: Five hundred and eleven cases were included (Mean age 62, 64% male). 58 (11%) cases had pre-existing cirrhosis and 110 (21%) had diabetes. Three hundred and three patients required admission (59%), totalling 2747 inpatient bed days. Seventeen (3.3%) HEV-related deaths were recorded. Factors that predicted mortality included haematological malignancy (OR 51.56, 95% CI 3.40-782.83, P = 0.005), cirrhosis (OR 41.85, 95% CI 2.85-594.16, P = 0.006), higher serum bilirubin (OR 1.01, 95% CI 1.01-1.02, P = 0.011) and chronic HEV infection (OR 0.02, 95% CI 0.02-0.28, P < 0.001). HEV infection affected 35 transplant patients of 106 total immunosuppressed patients (21%). Of these, 25 patients received Ribavirin therapy with a sustained virological remission of 76%. Thirty-five (6.7%) patients developed acute or acute-on-chronic liver failure with two requiring transplant. Thirty-seven (7.2%) patients reported neurological complications with 10 developing neuralgic amyotrophy, 6 Guillain-Barré and 2 encephalitis. Forty-four (8.6%) patients developed acute kidney injury. Conclusion: In Scotland, HEV causes a significant burden of inpatient admissions, organ failure and death. Cirrhosis and haematological malignancy are significant predictors of mortality. Neurological and renal complications occur in a significant minority.

Original languageEnglish
Pages (from-to)974-986
Number of pages13
JournalAlimentary Pharmacology & Therapeutics
Volume51
Issue number10
Early online date14 Apr 2020
DOIs
Publication statusPublished - 27 Apr 2020

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    Wallace, S. J., Swann, R., Donnelly, M., Kemp, L., Guaci, J., Murray, A., Spoor, J., Lin, N., Miller, M., Dalton, H. R., Hussaini, S. H., Gunson, R., Simpson, K., Stanley, A., & Fraser, A. (2020). Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: a multicentre retrospective study. Alimentary Pharmacology & Therapeutics, 51(10), 974-986. https://doi.org/10.1111/apt.15704