Abstract
BackgroundStudies on Epstein-Barr virus (EBV) have focused mostly on neoplastic disease. Few studies have considered immunocompetent patients who are not severely immunocompromised. Liver cirrhosis is associated with various levels of immune dysfunction. In the current study, we determined EBV infection rates, the influence on liver function, and analyzed the risk factors for death in patients with liver cirrhosis.MethodsThe medical records of patients diagnosed with liver cirrhosis between 1 January 2014 and 31 December 2016 were reviewed. Patients who were or were not infected with EBV were enrolled in this study. Liver functions were compared. The risk factors for 28-, 90-, and 180-day mortality rates were analyzed by univariate and multivariate logistic regression.ResultsThe medical records hospitalized patients diagnosed with liver cirrhosis were reviewed. Of these patients, 97 had assessed EBV deoxyribonucleic acid (DNA) and 36 (37.1%) patients were EBV DNA-positive. The age of the EBV-infected patients was older than patients not infected with EBV. EBV-infected patients had a lower level of albumin, and a lower albumin-to-globulin ratio (P = 0.019 and P = 0.013, respectively). EBV-infected patients had higher Child-Pugh scores (P = 0.033) and higher acute-on-chronic liver failure (ACLF) rate (P = 0.050). The Child-Pugh score and ACLF were the risk factors for the 28-, 90-, and 180-day mortality rates.ConclusionsThis study revealed that patients with liver cirrhosis had higher EBV infection rates, especially patients > 60 years of age, which likely reflected viral reactivation. And liver injury was aggravated in EBV-infected patients. Thus, EBV infection indirectly influenced the prognosis of EBV-infected patients by increasing the Child-Pugh score and ACLF rate.
Highlights
Studies on Epstein-Barr virus (EBV) have focused mostly on neoplastic disease
Demographic, clinical characteristics, and EBV infection We identified 3901 hospitalized patients who were diagnosed with liver cirrhosis from 1 January 2014 to 31 December 2016. 3794 patients were excluded because EBVDNA was not assessed, and 10 patients were exclued because of various reasons (Fig. 1)
The Child-Pugh score, model for end-stage liver disease (MELD) score, acute-on-chronic liver failure (ACLF), hepatic encephalopathy, hypoalbuminemia, international normalized ratio (INR), ascites, and hepatocellular carcinoma were shown to be risk factors for 180-day transplant-free mortality; we found that the Child-Pugh score and ACLF were the risk factors by multivariate logistic regression. (Tables 3, 4, 5)
Summary
Studies on Epstein-Barr virus (EBV) have focused mostly on neoplastic disease. We determined EBV infection rates, the influence on liver function, and analyzed the risk factors for death in patients with liver cirrhosis. Primary EBV infections primarily occur in childhood, manifesting as infectious mononucleosis with fever, angina, lymphadenectasis, hepatomegaly, Studies on EBV have focused on patients with neoplastic disease [4] and post-transplant lymphoproliferative disorders after hematopoietic stem cell transplantation [5,6,7]. Autoimmune liver diseases, including autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis, have a potential causative link with EBV [11]. Vine et al [12] reported that in patients presenting with jaundice/hepatitis, EBV hepatitis is an uncommon diagnosis and causes a self-limiting hepatitis. Ulug et al [13] have reported a case of acute hepatitis associated with acute EBV infection. Gupta et al [14] have described two cases of acute hepatitis after EBV infection
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