ACUTE HEPATITIS IN OKINAWA, JAPAN-ANALYSIS OF 277 CASES

Abstract

Purpose: To eastablish the clinical and laboratory features of acute hepatitis diagnosed and treated at 500-bed teaching hospital in Okinawa, Japan. Methods: “Acute hepatitis” was defined as a case with the following. (1) A case without previous history of jaundice, abdominal girth, variceal bleeding or PSE. (2) A case without previous laboratory, serological or pathological diagnosis of chronic hepatitis or cirrhosis. (3) A case of acute or subacute presentation of symptoms as jaundice, general fatigue or darkened urine. (4) A case with elevated ALT, AST or Alkaline phosphatase above twice normal. 277 patients with acute hepatitis during phase I(1989–1993) and phase II(1999–2003) were examined retrospectively. Results: 150 patients were in the phase I (75 males and 80 females) and 122 patients were in the phase II(55 males and 67 females). Among phase I there were 13(8.7%), 5(3.3%), 29(19.3%), 36(24%) and 39(26%) patients with acute hepatitis B, C, drug induced liver damage, liver damage with other medical problems and unknown etiology, respectively. Among phase II there were 5(4.1%),16(13.1%),9(7.3%),21(17.2%),29(23.8%) and 16(13.1%) patients with hepatitis A, acute hepatitis B, autoimmune hepatitis, drug induced liver damage, liver damage with other medical problems and unknown etiology, respectively. “Other medical problems” including, sepsis (21 cases-35.6%), shock(8-13.6%), malignancy(6-10.1%) pneumonia(5-8.5%) and ischemic heart disease(4-6.8%). Among hepatitis A, acute hepatitis B and etiology unknown acute liver damage (EUALD), maximal ALT was significantly higher in hepatitis A and acute hepatitis B than EUALD(hepatitis A vs Hepatitis B vs EUALD = 3664.3 vs 2290.8 vs 704.4, p <0.05) and maximal T-bili was significantly higher in hepatitis B than hepatitis A and EUALD (hepatitis A vs Hepatitis B vs EUALD = 6.5 vs 13.9 vs 3.8, p <0.05). Conclusions: Acute hepatitis experienced by us revealed features as; Total number of cases in phase II was less than in phase I. There were significant cases of drug induced liver damage and liver damage with other medical problems both in phase I and II. Acute hepatitis with unknown etiology seems to be milder elevation of T-bili and ALT than hepatitis A or acute hepatitis B.