Chronic Hepatitis B Increases Liver-Related Mortality in Acute Hepatitis E Infection

A population cohort study evaluated the effects of chronic hepatitis B infection on mortality rates of people infected with acute hepatitis E.

Chronic hepatitis B infection is an important risk factor for liver-related mortality in patients with acute hepatitis E infection, according to a retrospective population-level cohort study published in Clinical Infectious Diseases.

The epidemiology of acute hepatitis A and E has been changing over the years, and the effect of concomitant chronic hepatitis B on clinical outcomes is uncertain. Therefore, using electronic medical records from the Hospital Authority of Hong Kong, researchers identified 1068 cases of acute hepatitis A and 846 cases of acute hepatitis E from January 2000 to December 2016.

They found that more patients with acute hepatitis E had underlying chronic hepatitis B than patients with acute hepatitis A (13.5% vs 8.0%, respectively; P <.001). They also found that patients with hepatitis E had more all-cause mortality (3.9% vs 0.6%, respectively; P <.001), liver-related mortality (2.0% vs 0.3%, respectively; P <.001), and hepatic events (2.8% vs 0.3%, respectively; P <.001) within 30 days from diagnosis compared with patients with acute hepatitis A.

Underlying renal failure and age ³50 years were associated with 30-day all-cause mortality in patients with acute hepatitis E, whereas chronic hepatitis B was associated with 30-day liver-related mortality.

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In 1 of the largest population-based studies on acute hepatitis A and E, mortality was found to be higher in patients with hepatitis E than in patients with hepatitis A. In addition, coexisting chronic hepatitis B is an independent risk factor for liver-related mortality in patients with acute hepatitis E.

“Policy makers of countries or regions endemic with chronic hepatitis B virus infection should be proactive to implement targeted vaccination for [hepatitis E virus] in subjects who are at increased risk of mortality,” concluded the authors.


Lai JCT, Wong GLH, Yip TCF, et al. Chronic hepatitis B increases liver-related mortality of patients with acute hepatitis E–a territory-wide cohort study from 2000 to 2016 [published online March 21, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy234