关键词: 急性戊型肝炎, 临床特征, 肝衰竭, 老年人, 预后

Abstract: Objective To study on the clinical characteristics and prognosis of hepatitis E, and to explore the risk factors for its progression to liver failure. Methods The clinical data of 109 patients with acute hepatitis E were retrospectively analyzed. The patients were divided into an elderly group (n=37) and a non-elderly group (n=72) according to the patients′ age. Based on their comorbidities the patients were classified into an acute hepatitis E group (n=86) and an acute hepatitis E combined with other liver diseases group (n=23). The patients were further categorized into a liver failure group (n=23) and a non-liver failure group (n=86) based on whether they progressed to liver failure. The clinical characteristics, laboratory indicators, and treatment outcomes among the groups were compared. Results Within the 109 patients, 35 cases were cured, 61 cases improved. The peak values of alkaline phosphatase (ALP), total bilirubin (TBiL) and international normalized ratio (INR), the incidences of jaundice and complications of ascites and hepatic encephalopathy, the rate of liver failure, hospital stay duration, and the hospitalization costs of the elderly group were higher than those of the non-elderly group (P<0.05), whereas the levels of TCHOL (total cholesterol) and HDL-C (high-density lipoprotein cholesterol), valley value of Alb (albumin), and the cure rate of the elderly group were lower than those of the non-elderly group (P<0.05). There were no statistically significant differences between the two groups in terms of gender composition, other symptoms, the rates of other complication, the rates of improvement or inefficacy (P>0.05). In the group of patients with hepatitis E combined with other liver diseases, the peak values of TBiL, the peak values of PT (prothrombin time), the peak values of INR, the incidence of symptoms abdominal distension and fatigue, the incidence of complications ascites and hepatic encephalopathy, and the rate of liver failure were all higher than those of the hepatitis E group (P<0.05), whereas the valley value of Alb and the level of low-density lipprotein cholesterol (LDL-C) of patients in the hepatitis E combined with other liver diseases group were lower than those of the hepatitis E group (P<0.05). There were no statistically significant differences between the two groups in terms of gender composition, age distribution, hospital stay duration, hospitalization costs, cure rate, and improvement rate (P>0.05). In the liver failure group, the peak values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), TBiL, PT, activated partial thromboplastin time (APTT), INR, globulin (GLO), and triglyceride (TG), the incidences of symptoms such as jaundice, abdominal distension, fatigue, poor appetite, skin itching and dark urine, the incidences of complications including hypoproteinemia, ascite, hepatic encephalopathy, hospitalization duration, hospitalization costs and improvement rates were all higher than those in the non-liver failure group (P<0.05), whereas the valley value of Alb, TCHOL and HDL-C levels, as well as the cure rate of patients in the liver failure group were lower when compared to those of the non-liver failure group. There were no statistically significant differences between the two groups in terms of gender composition, inefficacy, peak values of ALP, γ-glutamyl transpeptadase (GGT), creatinine (Cr), urea (Ur), and LDL-C (P>0.05). The indicators with statistically significant differences between the two groups were included in binary Logistic regression analysis, and the peak value of INR and TBiL were found to be independent risk factors for liver failure in patients with hepatitis E (P<0.05). Conclusion Elderly patients and those with hepatitis E combined with other liver diseases tend to have more severe conditions, with a higher incidence of ascites, complications such as hepatic encephalopathy, and liver failure. Therefore, it is important to enhance the screening and monitoring of hepatitis E in these two populations. Binary logistic regression analysis found that the peak values of INR and TBiL are independent risk factors for the progression of hepatitis E to liver failure.

Key words: Acute Hepatitis E, Clinical characteristics, Liver failure, Elderly individuals, Prognosis