关键词: 戊型肝炎相关肝衰竭, 多器官功能衰竭, 高胆红素血症

Abstract: Objective To summarize the clinical data of patients with hepatitis E -related liver failure, to analyze the causes of liver failure, and to identify the independent risk factors affecting their prognosis, with the aim of improving clinical diagnosis and treatment capabilities. Methods A retrospective analysis was conducted on 81 patients with hepatitis E-related liver failure who were admitted to No.904 Hospital of the Joint Logistics Support Force of the People′s Liberation Army between January 2020 and June 2024. Their clinical manifestations and signs were collected, and their outcomes were followed-up. Based on their clinical outcomes, the patients were categorized into a survival group and a death group. The clinical data were compared between the two groups of patients and the factors influencing the patients′ prognosis were analyzed. Results The common clinical manifestations and signs in patients with hepatitis E-related liver failure predominantly include jaundice, ascites, and fatigue. Additional symptoms encompass loss of appetite, nausea and vomiting, and dull pain in the right upper quadrant. Among 81 patients, 68 survived while 13 died due to progressive deterioration. The causes of death included: multiple organ failure in 7 cases (53.8%), severe infection in 4 cases (30.8%), cerebral edema/intracranial hypertension in 1 case (7.7%), and acute pancreatitis in 1 case (7.7%). The median survival time from disease confirmation to death was 12 days (range: 7~35 days). Compared with the survivors, the deceased patients exhibited significantly higher values in parameters including age, incidence of multiple organ failure, hyperbilirubinemia, alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), Creatinine (Cr), blood lactate, blood ammonia, International Normalized Ratio (INR), and model for end-stage liver disease (MELD) score (P<0.05), whereas their Platelet (PLT) levels were significantly lower (P<0.05). By multivariate logistic regression analysis it was identified that age, multiple organ failure, and hyperbilirubinemia were independent risk factors for the mortality of patients with hepatitis E-induced liver failure (P<0.05). Conclusion Age, multiple organ failure, and hyperbilirubinemia are independent risk factors for death in patients with hepatitis E-related liver failure. It is essential to strengthen dynamic monitoring of multi-organ function, especially respiratory, renal, and coagulation functions, and to closely follow-up the trend of bilirubin levels in order to provide a basis for the formulation of individualized intervention strategies.

Key words: Hepatitis E virus related liver failure, Multiple organ failure, Hyperbilirubinemia