Effect of Acute Hepatitis E Infection in Patients with Liver Cirrhosis

Introduction: Hepatitis E virus is a major cause of enterically transmitted hepatitis. Mortality is very high if it is associated with pregnancy, especially during third trimester. This study was carried out to find out the effects of acute HEV hepatitis on Chronic Liver Disease patients of different etiologies. Methods: The consecutive patients of liver cirrhosis with definite evidence of recent HEV infection were enrolled in this study. Acute hepatitis was diagnosed by presence of prodromal symptoms and anti-HEV IgM antibody in their serum. The outcomes after superinfection with HEV hepatitis were determined by changes in Child Pugh score, recovery of liver function test, hospital stay and mortality. Results: After exclusion 25 were studied. The etiology of cirrhosis in patients was: alcohol 13, autoimmune hepatitis 3, hepatitis B 2, Budd Chiari syndrome 2, alcohol plus hepatitis B 1, hepatitis C 1, cardiac cirrhosis 1, Wilson's disease 1 and cryptogenic 1. All patients with no recent decompensation showed signs of decompensation during admission. Seven (28%) patients died. The cause of death was either upper gastrointestinal bleeding or hepatorenal syndrome. Remaining patients had prolonged hospital stay with deterioration of Child-Pugh's score. Conclusions: Superinfection of HEV in cirrhotic patient causes rapid decompensation. The morbidity and mortality is higher compared to those non-infected patients. Development of hepatorenal syndrome and upper GI bleeding was commonest cause of death.