Abstract: Objective To explore the characteristics of severe jaundice caused by acute hepatitis E and to construct an early warning model. Methods This is a retrospective analysis of the medical records of 122 patients with acute hepatitis E who received treatment at the Second Affiliated Hospital of Air Force Medical University from January 2021 to January 2023. According to the 80/20 law, they were randomly divided into a training set (N=96 cases) and a validation set (N=26 cases). The patients were divided into a severe group and a mild to moderate group based on whether they occurred severe jaundice during hospitalization. The risk factors for severe jaundice in acute hepatitis E were analyzed, and a warning model for severe jaundice in acute hepatitis E patients were constructed and verified. Results Among the 96 cases of acute hepatitis E, 42 cases developed severe jaundice, with an incidence rate of 43.75% (42 cases/96 cases). 18 cases exhibited obvious symptoms such as fever, poor appetite, muscle soreness, abdominal distension, and vomiting; 54 cases (56.25%) of patients had mild to moderate jaundice. The proportion of liver failure in the severe group was higher than that in the mild to moderate group (P<0.05). The baseline, total bilirubin (TBil) peak, creatinine peak, neutrophil peak, alpha fetoprotein (AFP), and liver elasticity, the value of anti-hepatitis E virus immunoglobulin M antibody (HEV IgM) in the severe group were higher than those in the mild to moderate group (P<0.05). Anti-HEV IgM baseline (OR=3.564, 95% CI=1.751~7.255), peak TBil (OR=3.778, 95% CI=1.856~7.687), peak creatinine (OR=3.688, 95% CI=1.812~7.506), peak neutrophil count (OR=4.216, 95% CI=2.072~8.582), and AFP (OR=4.559, 95% CI=2.239~9.278) are risk factors for severe jaundice in acute hepatitis E (P<0.05). The sensitivity of the risk model for predicting severe jaundice in acute hepatitis E in the training set was 0.827 (95% CI=0.735~0.941), the specificity was 0.834 (95% CI= 0.715~0.941), and the area under the curve was 0.843 (95% CI=0.731~0.928). The sensitivity of the risk model prediction validation set for severe jaundice in acute hepatitis E was 0.731 (95% CI=0.625~0.901), the specificity was 0.828 (95% CI= 0.713~0.947), and the area under the curve was 0.831 (95% CI=0.728~0.951). Conclusion Anti HEV-IgM baseline, TBil peak, creatinine peak, neutrophil peak, and AFP level are associated with severe jaundice in acute hepatitis E. The Construction of an early warning model may help to identify the risk of severe jaundice in acute hepatitis E patients.

Key words: Acute hepatitis E, Severe jaundice, Influencing factors, Early warning model