What is the relative frequency of E etiology in AVH

1
Arora Clinical spectrum of hepatitis E

• What is the relative frequency of E etiology in
  AVH?
• Duration of study January, 2001- October, 2004,
  patients 313
• Mean age Male34.10, range 5-78, Female34.01,
  range 6-70
• Sex ratio Male Female 3.1 1
• Viral Hepatitis no. of
• patients
• A 53 17
• B 75 24
• E 131 42
• Drug induced 31 10
• Non A-E 23 7

2
Arora Clinical spectrum of hepatitis E

• Age and Sex distribution in Hepatitis E patients
• Total no. of HEV patients 131
• Mean age Male34.14 (n105) (range 11-64 yr)
• Female34.05 (n26) (range 12-62)
• Sex ratio Male Female 3.71
• Age Male Female Total
• 11-20 15 05 20
• 21-30 38 13 50
• 31-40 15 08 22
• 41-50 18 01 19
• 51-60 18 00 18
• 61-70 01 01 02
• ---- ---- ----
• Total 105 28 131

Age range Patients (n131) 11-20
15.26 21-30 38.17 31-40 16.80 41-50
14.50 51-60 13.75 61-70 1.52
3
Arora Clinical spectrum of hepatitis E

• Serum bilirubin lt 10 at 4 wks
• N 72/131 (55)
• Mean age(yrs.) Range
• Male 31.7 11-58
• Female 32.7 12-62
• Sex ratio MF3.21

Serum bilirubin gt 10 at 4 wks N59/131 (45) Mean
age(yrs.) Range Male 34.5 15-64 Female
35.15 18-40 Sex ratio M F4.31
4
Arora Clinical spectrum of hepatitis E

• LFT Profile in HEV cholestatic hepatitis
• Total No. of patients51 (38.93)
• M F 3.21
• Range
• Serum Bilirubin 16.26 0.4-64.3
• SGOT 1233.15 15.4-7755
• SGPT 1365.29 17-7140
• ALP 311.56 63-745
• P. Time 14.14 9.2-37

LFT profile in HEV non-cholestatic hepatitis Sex
ratio Total no. of patients80 (61.07) M F
6.21 Range Serum Bilirubin 9.59 0.4-64.3
SGOT 1470.57 24-7755 SGPT 1515 17-7140 ALP
313.10 53-1260 P.Time14.16 1.2-52
5
Arora Clinical spectrum of hepatitis E

• Conclusions
• Acute viral hepatitis E is the commonest cause of
  acute sporadic hepatitis in North India
• Males are affected more than females in ratio 31
• Mean age of the patients is 34 yrs.
• 45 of the patients have serum bilirubin gt
  10mg/dl
• 38 of the patients have cholestasis hepatitis
• Liver function test profiles of the cholestatic
  and non-cholestatic patients are not different
  from each other.

6
Command Hospital (NC) Udhampur
Total 944 cases
Command Hospital (CC) Lucknow
Army Hospital (RR) Base Hospital Delhi
Command Hospital (SC) Pune
Command Hospital (EC) Calcutta
INHS Aswini, Mumbai
Command Hospital (AF) Bangalore
7
Anand Clinical spectrum of hepatitis E
What is the relative frequency of E etiology in
AVH?
Total 944 cases
8
Anand Clinical spectrum of hepatitis E

• What is the age and sex distribution?
• Mean age of the 944 patients selected for this
  study was 28.9 (range 14-56) years
• Majority of them were males (866/944, 91.7).
• Service bias

9
Anand Clinical spectrum of hepatitis E
What is the proportion of patients with severe
hepatitis (serum bilirubin gt 10mg/dl at 4 weeks
of onset of icteric phase)
10
Anand Clinical spectrum of hepatitis E
What are the characteristics of LFT profile in
HEV cholestatic hepatitis? (Peak values in 31
cases)
11
Anand Clinical spectrum of hepatitis E
What is frequency of association of acute HEV
with alcoholic liver disease, diabetes mellitus?
12
Etiological pattern of acute viral hepatitis
Dixit Clinical spectrum of hepatitis E
Acute viral hepatitis Total No.
104 Period of study Jan. 03-Oct.04 Inpatients
64 ( 63) Out patients
40 ( 37)
13
Age and sex distribution
Dixit Clinical spectrum of hepatitis E
14
Mean serum bilirubin in cholestatic hepatitis
(HEV)
Proportion of severe hepatitis

p lt 0.05
15
Mean ALT levels in cholestatic hepatitis (HEV)
Dixit Clinical spectrum of hepatitis E


P lt 0.05
16
Mean alkaline phosphatase levels in cholestatic
hepatitis (HEV)
Dixit Clinical spectrum of hepatitis E
17
Dixit Clinical spectrum of hepatitis E

• Association With Hepatitis E
• Total no. of AVH -104
• Acute Hepatitis (HEV) - 77
• Alcoholic Liver Disease - 4 /77 (5)
• Diabetes Mellitus - 9 / 77(12)

18
Misra Clinical spectrum of hepatitis E
Relative frequency of hepatitis E in AVH Hep E
85 Hep B 15 Occasionally Hep A Age and Sex
distribution of patients with prolonged
(cholestatic) hepatitis gt 6 weeks) 50
patients Male 36, females 24 Age in adults
median 38 5 children aged 2.5-5 years
19
Misra Clinical spectrum of hepatitis E
Viral hepatitis associated with cholestasis 50
patients with prolonged viral (cholestatic)
hepatitis (gt 6 weeks) during last 2 years HEV 19
(38) HAV 8 (16) HBV 18 (36) HEV and HAV in 5
(10). All children seen during the last two
months
Association with alcoholism and diabetes 7 of 50
diabetics 3 Hep E, 4 Hep B Only one of 50
alcoholic Hep E
20
Misra Clinical spectrum of hepatitis E
Hep E Bil ALT AST Alk Phos PT 13.5(7-35) 705(
90-2020) 405 (68-700) 550 (100-1580) n to gt6
Hep A and E 12.8 (6-21) 550 (90-1070) 310
(70-800) 450 (270-1100) n
21
Tandon Clinical spectrum of hepatitis E

• Etiology of Frequency
• Acute Hepatitis (n100)
• HEV 36
• HBV 33
• HAV 21
• Indeterminate/ Alcohol/
• Autoimmune 10
• Age 30-40 Yrs (Average 35 Yrs)
• Sex M F 41

22
Tandon Clinical spectrum of hepatitis E

• Severe acute hepatitis E
• ie. gt 10mg at 4 wks after onset of icteric
  phase 30/ 36 ie 83
• Symptoms
• Jaundice prodromal symptoms 100
• Itching 50
• Mean duration of Illness 3 wks at time of
  admission

23
Tandon Clinical spectrum of hepatitis E

• LFT in acute severe hepatitis E
• S. Bilirubin (Total) 18.3mg
• SGOT 687IU/L
• SGPT 785IU/L
• Alk Phosphatase 418 (n306)
• PT (INR) 1.4
• Time taken for normalization of LFT average 39
  days (approx. 6 weeks)
• Associated medical conditions
• DM - 8/36 22
• Alcohol Consumption 9/36 25
• Treatment
• Parenteral Glycyrrhizin 40ml IV daily
• Wysolone (9/30 30)

24
Tandon Clinical spectrum of hepatitis E

• Summary
• Hepatitis E accounts for 1/3 of all AVH seen at
  our centre.
• Young patients in 3rd 4th decade
• Mostly males
• Significant proportion have severe hepatitis
  requiring hospitalization and specific therapy
• Jaundice and itching are common symptoms
• Most patients present late approx 3 weeks after
  onset of icteric phase
• Liver function profile indicates deep jaundice
  and cholestasis.
• IV Glycyrrhizin and wysolone are useful
  therapeutic agents.
• DM alcohol consumption hinder recovery and are
  associated with prolonged morbidity