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Yoo, Kim, Jang, Choi, Moon, Park, Lee, Kim, Kim, Lee, Lee, Kim, Cho, and Jung: Clinical Features and Risk Factors for Severe Complications among Patients with Acute Hepatitis A Virus Infection in The Jeonbuk Province of Korea
Original Article

Korean J Gastroenterol 2014;63(1):25-31.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.1.25

Clinical Features and Risk Factors for Severe Complications among Patients with Acute Hepatitis A Virus Infection in The Jeonbuk Province of Korea

Sun Ho Yoo, In Hee Kim, Ji Won Jang, Chung Hwan Choi, Jin Chang Moon, Jin Kyoung Park, Sang Youn Lee, Seong Hun Kim, Sang Wook Kim, Seung Ok Lee, Soo Teik Lee, Dae Ghon Kim, Eun Young Cho1, Gum Mo Jung2

Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea

1Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, Korea

2Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea

Correspondence to: In Hee Kim, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. Tel: +82-63-250-1677, Fax: +82-63-254-1609, E-mail: ihkimmd@jbnu.ac.kr

Received 30 August 2013       Revised 4 December 2013       Accepted 6 December 2013

Copyright © 2014 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The frequency of symptomatic acute HAV infections in adulthood are increasing in Korea. This study analyzes the clinical severity in patients with acute HAV infection and investigates risk factors associated with three severe complications: prolonged cholestasis, acute kidney injury, and acute liver failure.

Methods

We performed a retrospective analysis of 726 patients diagnosed from January 2006 to December 2010 at three tertiary hospitals in Jeonbuk Province, Republic of Korea with acute HAV infection.

Results

In the group of 726 patients, the mean age was 30.3 years, 426 (58.6%) were male, and 34 (4.7%) were HBsAg positive. Severe complications from acute HAV infection occurred as follows: prolonged cholestasis in 33 (4.6%), acute kidney injury in 17 (2.3%), and acute liver failure in 16 (2.2%). Through multivariate analysis, age ≥40 years (OR 2.63, p=0.024) and peak PT (INR) ≥1.5 (OR 5.81, p=0.035) were found to be significant risk factors for prolonged cholestasis. Age ≥40 years (OR 5.24, p=0.002) and female gender (OR 3.11, p=0.036) were significant risk factors for acute kidney injury. Age ≥40 years (OR 6.91, p=0.002), HBsAg positivity (OR 5.02, p=0.049), and peak total bilirubin (OR 1.11, p=0.001) were significant risk factors for acute liver failure.

Conclusions

Age ≥40 years, female gender, HBsAg positivity, peak PT (INR) ≥1.5, and peak total bilirubin were significant risk factors for severe complications in acute HAV infections.

Keywords: Hepatitis A, Cholestasis, Acute kidney injuries, Acute liver failure, Risk

References

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Table 1.
Comparison of Clinical Characteristics of Acute HAV Infection Patients with the Presence of Prolonged Cholestasis
Variable Prolonged cholestasis (n=33) Non-cholestasis (n=693) p-value
Age (yr) 35.0±12.4 30.1±9.4 0.004
Age ≥40 years 9 (27.3) 83 (12.0) 0.010
Female 20 (60.6) 277 (40.0) 0.441
HBsAg positivity 1 (3.0) 33 (4.8) 0.646
Anti-HCV positivity 0 (0) 1 (0.1) ＞0.999
Laboratory values at admission      
 White blood cells (/mm3) 5,904±4,061 5,387±2,380 0.473
 Hemoglobin (g/dL) 14.4±1.9 14.4±1.7 0.915
 Platelet (103/mm3) 164.6±88.9 171.1±85.9 0.678
 Prothrombin time (INR) 1.4±0.5 1.2±0.3 0.019
 Prothrombin time (INR) ≥1.5 14 (42.4) 91 (13.1) ＜0.001
 Total bilirubin (mg/dL) 4.7±3.5 4.7±4.2 0.963
 AST (IU/L) 1,868±2,150 2,070±2,549 0.654
 ALT (IU/L) 2,084±1,993 2,290±1,916 0.548
 Creatinine (mg/dL) 0.7±0.2 0.8±0.3 0.440
Laboratory values at peak time      
 Prothrombin time (INR) 1.8±1.4 1.3±0.5 0.053
 Prothrombin time (INR) ≥1.5 14 (42.4) 123 (17.7) ＜0.001
 Total bilirubin (mg/dL) 20.3±11.8 6.4±3.6 ＜0.001
 AST (IU/L) 4,377±5,636 2,357±2,560 0.049
 ALT (IU/L) 3,208±2,772 2,665±1,976 0.275
 Creatinine (mg/dL) 2.0±2.8 1.0±0.9 0.065
Hospitalization time (day) 44.7±18.8 11.1±5.2 ＜0.001

All results were presented as mean±SD or n (%).

Table 2.
Comparison of Clinical Characteristics of Acute HAV Infection Patients with the Presence of Acute Kidney Injury
Variable Acute kidney injury (n=17) Non-acute kidney injury (n=709) p-value
Age (yr) 37.2±7.3 30.1±9.6 0.003
Age ≥40 years 7 (41.2) 85 (12.0) ＜0.001
Female 12 (70.6) 285 (40.2) 0.024
HBsAg positivity 1 (5.9) 33 (4.7) 0.562
Anti-HCV positivity 0 (0) 1 (0.1) ＞0.999
Laboratory values at admission      
 White blood cells (/mm3) 7,786±5,168 5,353±2,355 0.071
 Hemoglobin (g/dL) 14.6±2.7 14.4±1.7 0.767
 Platelet (103/mm3) 118.9±52.7 172.0±86.3 0.012
 Prothrombin time (INR) 1.4±0.4 1.2±0.3 0.046
 Prothrombin time (INR) ≥1.5 6 (35.3) 99 (14.0) 0.026
 Total bilirubin (mg/dL) 4.4±2.5 4.7±4.2 0.795
 AST (IU/L) 1,167±1,440 2,083±2,548 0.140
 ALT (IU/L) 1,858±1,491 2,291±1,927 0.359
 Creatinine (mg/dL) 0.8±0.2 0.8±0.3 0.850
Laboratory values at peak time      
 Prothrombin time (INR) 1.6±0.5 1.3±0.6 0.101
 Prothrombin time (INR) ≥1.5 9 (52.9) 128 (18.1) ＜0.001
 Total bilirubin (mg/dL) 11.6±9.5 6.9±5.0 0.058
 AST (IU/L) 5,056±7,040 2,386±2,595 0.138
 ALT (IU/L) 3,152±2,700 2,679±2,001 0.483
 Creatinine (mg/dL) 6.7±3.5 0.9±0.2 ＜0.001
Hospitalization time (day) 20.9±13.8 12.5±9.3 0.023

All results were presented as mean±SD or n (%).

Table 3.
Clinical Characteristics of Acute HAV Infection Patients with the Presence of Acute Liver Failure
Variable Acute liver failure (n=16) Non-acute liver failure (n=710) p-value
Age (yr) 38.6±9.0 30.1±9.5 0.002
Age ≥40 years 7 (43.8) 85 (12.0) ＜0.001
Female 8 (50.0) 289 (40.7) 0.455
HBsAg positivity 3 (18.8) 31 (4.4) 0.007
Anti-HCV positivity 0 (0) 1 (0.1) 0.881
Laboratory values at admission      
 White blood cells (/mm3) 6,052±5,772 5,395±2,359 0.656
 Hemoglobin (g/dL) 14.9±1.0 14.4±1.7 0.856
 Platelet (103/mm3) 119±33.8 171±86.4 ＜0.001
 Prothrombin time (INR) 1.8±0.5 1.2±0.3 ＜0.001
 Prothrombin time (INR) ≥1.5 12 (75.0) 92 (13.0) ＜0.001
 Total bilirubin (mg/dL) 4.3±3.6 4.7±4.2 0.676
 AST (IU/L) 3,038±4,285 2,039±2,478 0.367
 ALT (IU/L) 2,490±2,566 2,276±1,903 0.659
 Creatinine (mg/dL) 0.8±0.2 0.9±0.9 0.685
Laboratory values at peak time      
 Prothrombin time (INR) 2.5±1.7 1.3±0.5 0.013
 Prothrombin time (INR) ≥1.5 16 (100.0) 105 (14.8) ＜0.001
 Total bilirubin (mg/dL) 15.0±14.2 6.9±4.7 0.036
 AST (IU/L) 7,391±6,049 2,337±2,583 0.004
 ALT (IU/L) 5,049±1,890 2,636±1,991 0.001
 Creatinine (mg/dL) 2.4±3.1 1.1±1.3 0.111
Hospitalization time (day) 18.1±10.7 12.5±9.5 ＜0.001

All results were presented as mean±SD or n (%).

Table 4.
Risk Factors Associated with Three Major Complications of Acute HAV Infection (Multivariate Analysis)
Major complicaion OR 95% CI p-value
Prolonged cholestasis      
 Age ≥40 years 2.63 1.136–6.076 0.024
 Peak prothrombin time 5.81 1.132–29.774 0.035
 (INR) ≥1.5      
Acute kidney injury      
 Age ≥40 years 5.24 1.861–14.743 0.002
 Female 3.11 1.079–8.936 0.036
Acute liver failure      
 Age ≥40 years 6.91 2.001–23.849 0.002
 HBsAg positivity 5.02 1.005–25.022 0.049
 Peak total bilirubin 1.11 1.043–1.190 0.001
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