P42-17. Outcomes of severe acute viral hepatitis B in Latvia

Jekaterina Kucina [1,2], Ieva Tolmane [2,3], Baiba Rozentale [1,2]
Affiliates: Riga Stradin’s University [1], Riga East University Hospital, Infectology Center of Latvia [2], University of Latvia [3]

Background
Approximately two billion people worldwide have evidence of past or present infection of hepatitis B. The overall prevalence of positive HBsAg is reported to be 3.6 percent. In acute viral hepatitis B successful clearance of virus is more than 95% of immunocompetent patients. Only 5% of patients develop chronic hepatitis B virus infection. Chronic infection is a major global health problem already and puts people at high risk of death from cirrhosis and liver cancer. Fulminant hepatitis occurs rarely – 0.1-0.5%. The study published in 2014 showed 20% of fulminant hepatitis survives and up to 80% of patients die. The aim of this study was to analyze outcomes of severe acute viral hepatitis B in Latvia.

Methods
This retrospective study included patients (n=32) with severe acute viral hepatitis B (AVH-B). All patients were treated in Infectology Center of Latvia from January 2005 to December 2015. Patients were classified as having severe AVH-B if they fulfilled any 2 of 3 criteria: hepatic encephalopathy, serum bilirubin ≥ 10.0 mg/dL and international normalized ratio (INR) ≥ 1.6. Statistical analysis was done, using SPSS version 20.0

Results
Study included 32 patients with mean age 44±16 years and average duration of hospitalization 22 days. 15 (46.9%) were males and 17 (53.1%) females. All patients (n=32) had severe acute viral hepatitis B treated with Lamivudine 100 mg daily. Three criteria of severe hepatitis was found in 19 (59%) of cases. None of the patients developed chronic hepatitis. In 22 (69%) cases serum HBsAg and HBeAg disappeared and they recovered. Three patients (9%) had unknown outcome, because they lost from follow-up, but 7 (22%) patients died. Statistically significant more severe coagulopathy was in patients group with lethal outcome, in comparison to patients in recovery group, INR=3.11 vs. INR =1.87, respectively, p=0.047. However, statistically significant difference between bilirubin, alanine aminotransferase and aspartate aminotransferase levels was not observed. All patients of lethal group had all 3 severe hepatitis criteria. 7 patients had fulminant hepatitis which resulted with liver coma and death. Two patients of lethal group had co-infection: chronic viral hepatitis C and acute viral hepatitis D. Three patients were immunosuppressed: one of them had prostate cancer, one had Hodgkin’s lymphoma, one patient had tetraparesis after vertebral fracture. One patient had Wilsons disease with cirrhosis.

Conclusions
Most patients with severe acute hepatitis B recovered (69%). Immunosuppressed patients or patients co-infected with other liver diseases more frequently had fulminant hepatitis or acute liver failure, which resulted in liver coma. Patients with fulminant or severe hepatitis must be considered for liver transplantation, because these patients have higher risk of acute liver failure. Method of treatment mainly is liver transplantation (AASLD 2011), unfortunately, in Latvia liver transplantation is not financed for adults.