Investigation of underlying comorbidities as risk factors for symptomatic human hepatitis E virus infection.
Investigation of underlying comorbidities as risk factors for symptomatic human hepatitis E virus infection.
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调查潜在的合并症作为有症状的人戊型肝炎病毒感染的危险因素。
DOI：
10.1111/apt.13938
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Chen L
中科院分区：
文献类型：
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作者：
Zhang S;Chen C;Peng J;Li X;Zhang D;Yan J;Zhang Y;Lu C;Xun J;Li W;Ling Y;Huang Y;Chen L
研究背景戊型肝炎病毒（HEV）感染的发病率较低，其危险因素尚不完全清楚，目的探讨影响HEV急性感染不良临床结局的危险因素。基线特征，临床结果，512例急性戊型肝炎病毒感染的实验室数据进行了分析，使用logistic回归models.ResultsAll患者表现出本土散发性戊型肝炎病毒感染，大多数是老年人。他们的症状从无症状到严重的肝脏疾病不等。共有215例患者（42.0%）发生肝功能衰竭和/或失代偿，45例（8.2%）患者在3个月内死亡。近60%的患者有潜在的慢性肝病（CLD），20%的患者有肝硬化，各种肝外潜在合并症很常见。Logistic回归分析显示，慢性肝病（尤其是肝硬化）与疾病严重程度密切相关（OR = 8.78，P < 0.001），但与死亡率无相关性。除了已知的因素（包括老年、男性和CLD）之外，我们还将既存的肝外肿瘤、糖尿病以及慢性呼吸道和肾脏疾病确定为不良临床结局的新的独立预测因素。重要的是，没有这四种肝外合并症的患者的死亡率（4.2%，P < 0.001）比有一种或多种合并症的患者（18.5%）（34.5%）低得多ConclusionsPrevious comorbidities，包括肿瘤，糖尿病，慢性肝，肺和肾脏疾病，是不良后果的独立危险因素，特别是死亡率，在急性HEV感染。本研究为进一步做好HEV感染的预防和控制工作提供了有价值的资料。
BackgroundSymptomatic Hepatitis E virus (HEV) infection occurs in few infected subjects, and the risk factors are not completely known.AimTo explore the risk factors for adverse clinical outcomes in acute HEV infections.MethodsA large retrospective study was conducted. The baseline characteristics, clinical outcomes, and laboratory data of 512 acute HEV infection cases were analysed using logistic regression models.ResultsAll patients exhibited autochthonous sporadic HEV infections, and most were elderly. Their symptoms varied from asymptomatic to severe liver diseases. In all, 215 patients (42.0%) had liver failure and/or decompensation, and 45 (8.2%) patients died within 3 months. Nearly 60% of patients had underlying chronic liver diseases (CLDs), 20% were cirrhotic, and various extrahepatic underlying comorbidities were common. The logistic regression analysis revealed that underlying CLDs, especially cirrhosis, were closely associated with disease severity (OR = 8.78,P< 0.001) but not with mortality in patients with severe liver diseases. In addition to the known factors, including an old age, the male gender and CLDs, we identified pre‐existing extrahepatic tumours, diabetes, and chronic respiratory and renal diseases as novel independent predictors for adverse clinical outcomes. Importantly, patients without these four extrahepatic comorbidities showed a much lower mortality rate (4.2%,P< 0.001) than patients with one (18.5%) or more comorbidities (34.5%).ConclusionsPrevious comorbidities, including tumours, diabetes, and chronic liver, lung and kidney diseases, were independent risk factors for adverse outcomes, especially mortality, in acute HEV infections. This study provides valuable data for improving the prevention and control of HEV infection.