Patients with acute hepatitis E have higher rates of mortality compared with patients with acute hepatitis A, according to study results published in Clinical Infectious Diseases.

The results of this study also indicated that comorbid chronic hepatitis B is an independent risk factor for liver-related mortality in patients with acute hepatitis E.

The study included participants with acute hepatitis A or E using hepatitis serology based on electronic medical records from the Hospital Authority of Hong Kong from January 2000 to December 2016. The researchers evaluated hepatic events, all-cause mortality, and liver-related mortality within 30 days of diagnosis.

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The researchers identified 1068 cases of acute hepatitis A and 846 cases of acute hepatitis E.

Participants with acute hepatitis E were more likely to have underlying chronic hepatitis B compared with participants with acute hepatitis A (13.5% vs 8.0%; P <.001). Compared with participants with acute hepatitis A, participants with acute hepatitis E had higher rates of all-cause mortality (3.9% vs 0.6%; P <.001), liver-related mortality (2.0% vs 0.3%; P <.001), and hepatic events (2.8% vs 0.3%; P <.001) within 30 days of diagnosis.

The researchers found that underlying renal failure (adjusted hazard ratio [aHR] 3.90; P <.001) and age ≥50 (aHR 3.25; P =.036) were associated with 30-day all-cause mortality in patients with acute hepatitis E. Chronic hepatitis B (aHR 3.34; P =.02) was associated with 30-day liver-related mortality.

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

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Lai JC, Wong GL, Yip TC, et al. Chronic hepatitis B increases liver-related mortality of patients with acute hepatitis E: a territorywide cohort study from 2000 to 2016. Clin Infect Dis. 2018;67(8):1278-1284.