Severe Viral Hepatitis Research Articles

Development of a dual channel detection system for pan-genotypic simultaneous quantification of hepatitis B and delta viruses

Hepatitis B virus (HBV) infection remains a major public health problem and, in associated co-infection with hepatitis delta virus (HDV), causes the most severe viral hepatitis and accelerated liver disease progression. As a defective satellite RNA virus, HDV can only propagate in the presence of HBV infection, which makes HBV DNA and HDV RNA the standard biomarkers for monitoring the virological response upon antiviral therapy, in co-infected patients. Although assays have been described to quantify these viral nucleic acids in circulation independently, a method for monitoring both viruses simultaneously is not available, thus hampering characterization of their complex dynamic interactions. Here, we describe the development of a dual fluorescence channel detection system for pan-genotypic, simultaneous quantification of HBV DNA and HDV RNA through a one-step quantitative PCR. The sensitivity for both HBV and HDV is about 10 copies per microliter without significant interference between these two detection targets. This assay provides reliable detection for HBV and HDV basic research in vitro and in human liver chimeric mice. Preclinical validation of this system on serum samples from patient on or off antiviral therapy also illustrates a promising application that is rapid and cost-effective in monitoring HBV and HDV viral loads simultaneously.

Low mortality despite temporary liver dysfunction in severe courses of acute hepatitis E

HepatitisE virus (HEV) infection can cause severe viral hepatitis and eventually liver failure. We aim to provide novel data on the epidemiology and the course of HEV infections from Q1/2008 to Q3/2018 at the Vienna General Hospital. Of the 88,945 people tested, we identified HEV-IgM positive (+) or HEV-PCR (+) patients and retrospectively collated information on the course of infection from patient records. Among 151 HEV-IgM or PCR (+) (median age 51years, 45.8% female), 7 (4.6%) had non-severe acute HEV infection (ALT ≥ 2-5-fold upper limit of normal, ULN), 11 (7.3%) had severe HEV infection without liver dysfunction (LD) (ALT > 5-fold ULN), and 9 (6.0%) with LD (ikterus or bilirubin > 5 mg/dL, OR coagulopathy or INR > 1.5, OR encephalopathy or ammonia > 100 µmol/L). HEV-RNA-PCR was performed in 58/190 (30.5%) HEV-IgM (+) patients and was positive in 19 (30.6%). Rates of HEV IgM/PCR positivity remained stable over the observation period. The HEV genotype (GT) was GT‑1 in 71.4% (n = 5) and GT‑3 in 28.6% (n = 2). Travel history was recorded for 9/20 (45.0%) of severe HEV and 12/20 (60.0%) patients with severe HEV infection were hospitalized. One patient with pre-existing liver disease and concomitant EBV infection required intensive care. No patient required transplantation and the 30-day mortality was 3/151 (1.9%). Despite the increased testing rates, the absolute number of diagnosed HEV infections at Vienna General Hospital remained constant between 2008 to 2018. Although approximately half of the patients with severe acute HEV infection required hospitalization, admissions to the intensive care unit (ICU) and short-term mortality were low.

Low seroprevalence of hepatitis delta virus co-infection in hepatitis B virus-infected blood donors in China: A multicenter study.

Hepatitis delta virus (HDV) coinfected with HBV causes severe viral hepatitis, however, the number of HDV infection may be underestimated. In the present study, we enrolled 1,141,331 blood donations, routinely tested for HBsAg and/or HBV DNA, from 21 blood establishments in China. 2,690 donors were HBsAg and/or HBV DNA positive after screening tests. After verification of HBsAg and HBV DNA, 1,490 samples were HBsAg confirmed-positive, including 1,459 HBV DNA-positive samples, and 825 samples were seronegative but HBV DNA positive. We first analyzed demographic characteristics of involved 2,690 donors with different HBV infection status and found the proportions of males, the older donors, workers and farmers were higher in HBsAg-/HBV DNA+ group. Then we evaluated specificity of HDV IgG and IgM antibody assays with 375 HBsAg and HBV DNA confirmed-negative samples, and 374 were tested negative using the two assays, respectively, suggesting a specificity of 99.73% for both assays (374/375, 95% Cl: 98.51-99.95%). Subsequently, we tested for HDV IgG and IgM of 2,315 HBsAg and/or HBV DNA confirmed-positive samples, and nine showed reactivity for IgG, while two were reactive for IgM. All these 11 reactive samples were tested again with another HDV pan-Ig and IgM testing assays and HDV RNA, and only one donor was identified as HDV IgG positive and HDV RNA negative, showing an HDV seroprevalence of 0.067% (95%CI: 0.012-0.38%) among HBsAg-positive blood donors in China. The positive donor was followed up for 2 years after the donation date, and decreased antibody titer of HDV IgG and HBsAg conversion were observed, and the infection status of the donor was HDV infection with recovery and occult hepatitis B virus infection with genotype C2. These results indicated a low seroprevalence of HDV infection among blood donors and a low risk of HDV transmission through blood transfusion in China.

A Review of HDV Infection.

Hepatitis D is the most severe viral hepatitis. Hepatitis D virus (HDV) has a very small RNA genome with unique biological properties. It requires for infection the presence of hepatitis B virus (HBV) and is transmitted parenterally, mainly by superinfection of HBsAg carriers who then develop chronic hepatitis D. HDV has been brought under control in high-income countries by the implementation of HBV vaccination, and the clinical pattern has changed to a chronic hepatitis D seen in ageing patients with advanced fibrotic disease; the disease remains a major health concern in developing countries of Africa and Asia. Every HBsAg-positive subject should be tested for HDV serum markers by reflex testing, independently of clinical status. Vaccination against HBV provides the best prophylaxis against hepatitis D. The only therapy available so far has been the poorly performing Interferon alfa; however, several new and promising therapeutic approaches are under study.

Acute Viral Hepatitis in Diabetic and Nondiabetic Patients: Variable Outcomes

Diabetes mellitus is frequent in Pakistan, which is also notorious for severe viral hepatitis epidemics on a regular basis. According to the present study, the clinical results of acute hepatitis B with and without diabetes were compared. Place and Duration: This is cross-sectional descriptive study was held in the Medicine department of M. Islam Medical and Dental College Gujranwala for one-year duration from January 2021 to December 2021. Methods: Patients with diabetes (n = 110, A group) and those without diabetes (n = 120, B group) were divided into two groups of 230 AVH patients. Age, gender, and alanine aminotransferase (ALT) levels did not vary significantly between the two groups. All patients were monitored for a period of 12 months or until they were completely cured. Upper gastrointestinal endoscopy was conducted on all of the patients in order to provide greater insight into the development of potential problems. In addition, abdominal ultrasonography was performed on all of the patients. Results: 90 and 100 of the AVH cases in groups A and B were caused by the hepatitis E virus, respectively. Only 9 of 120 patients in group B had jaundice that lasted longer than 6 months, compared to 40 of 110 (36.4%) of patients in group A. I In both groups, HEV was the primary cause of AVH (group A: (81.9%); group B: (83.3 percent). In both groups, HBV was the second most common cause of AVH. Two patients in group B developed AVH as a result of HAV. In several individuals, the etiological cause of AVH was unknown. Conclusion: According to the results of this study, all patients with diabetes and acute viral hepatitis (AVH) should be continuously observed because there is a danger of severe liver damage and even death in these individuals. Keywords: acute viral hepatitis, diabetics, variables, outcomes

Ubiquitinated Hepatitis D Antigen-Loaded Microvesicles Induce a Potent Specific Cellular Immune Response to Inhibit HDV Replication in Vivo.

ABSTRACTHepatitis D is the most severe form of human viral hepatitis and currently lacks an efficient therapy. Dendritic cell-derived exosomes (Dexs) have been found to induce immune responses capable of eliminating viruses. However, the therapeutic potential of antigen-loaded exosomes in hepatitis D is still unknown. Recently, we designed exosomes loaded with ubiquitinated hepatitis delta virus (HDV) small delta antigen (Ub-S-HDAg) and then treated mice bearing replicating HDV with these exosomes to explore their antiviral effect and mechanism. Mature dendritic cell-derived exosomes (mDexs) were loaded with Ub-S-HDAg and their antivirus function was evaluated in mice with HDV viremia. Furthermore, the proportion of CD8+ cells, the ratio of Th1/Th2 cells, the postimmunization levels of cytokines were explored, and the Janus kinases (JAK)/signal transducer and activator of transcription (STAT) pathway was evaluated with a JAK2 inhibitor AG490. In Ub-S-HDAg-Dexs group, the HDV RNA viral load was significantly decreased compared with other groups by CD8+ cell enrichment and an increase Th1/Th2 cell ratio. Furthermore, lymphocyte infiltration was increased, while the HDAg level was decreased in mouse liver tissue. However, there were no significant differences in HBV surface antigen (HBsAg), alanine aminotransferase (ALT), or aspartate aminotransferase (AST) levels among the groups. Moreover, p-JAK2, p-STAT1, p-STAT4, STAT1, and STAT4 expression was increased in Ub-S-HDAg-Dexs group. In conclusion, Ub-S-HDAg-Dexs might be a potential immunotherapeutic agent for eradicating HDV by inducing specific cellular immune response via the JAK/STAT pathway.IMPORTANCE Hepatitis D is the most severe viral hepatitis with accelerating the process of liver cirrhosis and increasing the risk of hepatocellular carcinoma. However, there are no effective antiviral drugs. Exosomes derived from mature dendritic cells are used not only as immunomodulators, but also as biological carriers to deliver antigens to induce robust immune response. Based on these properties, exosomes could be used as a biological immunotherapy by enhancing adaptive immune response to inhibit hepatitis D virus replication. Our research may provide a new therapeutic strategy to eradicate HDV in the future.

A case of severe Epstein-Barr viral hepatitis with the development of hepatic cell failure and encephalopathy in a 1-year old child

Objective: The article describes a clinical case of severe Epstein-Barr viral hepatitis in a child aged 1.Materials and methods. The diagnosis of Epstein-Barr mononucleosis was confirmed by repeated isolation of Epstein-Barr virus DNA from the blood by PCR, and IgM to the capsid antigen detection in the blood. Atypical mononuclear cells in blood tests were not detected throughout the disease course.Results. The main clinical symptoms in the first 2 weeks of the disease included a fever, severe lymphoproliferative syndrome, persistent purulent tonsillitis, and maculopapular rash. Severe hepatic damage developed on 20th day from the onset of the disease. The fact that the disease had an unusually severe course made it necessary to conduct differential diagnosis with lymphoproliferative and hemophagocytic syndromes. The child received the treatment with low-dose interferon agents (interferon α-2b) in suppositories, glucocorticoids (prednisone 3 mg/kg/day), intravenous immunoglobulins, symptomatic therapy. Acyclovir therapy was not administered. The patient made a complete recovery with full normalization of liver function.

P-87 HIGH PREVALENCE OF SARS-COV-2 ANTIBODIES IN PREGNANT WOMEN INFECTED WITH VIRAL HEPATITIS IN BRAZIL

IntroductionPregnant women are considered more vulnerable to viral infections, such as severe viral respiratory infections and viral hepatitis. Data about Brazilian pregnant and postpartum women found a case fatality rate of 12.7% among COVID-19 Acute Respiratory Distress Syndrome cases (ARDS). Studies in pregnant women found prevalences of antibodies (Ab) against SARS CoV-2 between 4 to 14% in Europe and North America. However, there is no data about the prevalence of SARS CoV-2 Ab among Brazilian pregnant women with viral hepatitis.ObjectivesThe objective of this study was to assess the prevalence of SARS CoV-2 antibodies in pregnant women infected with hepatitis B or C.MethodsA total of 31 pregnant women (21 HBV and 10 HCV) were recruited in Rio de Janeiro (Brazil) from January 7, 2020 to January 11, 2021. The study protocol was approved by the Brazilian National research ethics committee. Serum samples were collected and tested for total antibody (Ab) and IgM Abs specific for SARS-CoV-2 using electrochemiluminescence assay (Elecsys Anti-SARS-CoV-2, Roche).ResultsPregnant women were at first (n=12), second (n=10) and third trimester of gestation (n=9). None of them had diabetic or are living with HIV, while three women presented arterial hypertension. Mean age was 30.6± 7.26 years old, 90.3% were black and 38.7% had up 8 years of education. Total anti-SARS-CoV-2 prevalence was 19.3% (6/31). Most of pregnant women were at first trimester of gestation, aged less than 35 years of old, and were black race. However, none of these variables were statistical associated to anti-SARS CoV-2 antibody positivity (table 1).ConclusionsThis is the first report of SARS CoV-2 seroprevalence in pregnant women infected with viral hepatitis, where seroprevalence appears to be greater than that observed in pregnant women without liver disease in the same period.

Risk of hepatocellular carcinoma in hepatitis B and D virus co-infected patients: A systematic review and meta-analysis of longitudinal studies.

Hepatitis D virus (HDV) infection causes a severe chronic viral hepatitis with accelerated development of liver cirrhosis and decompensation, but whether it further increases the risk of hepatocellular carcinoma (HCC) is unclear. We performed a comprehensive systematic review of the published literature and meta-analysis to assess the risk of HCC in HDV and hepatitis B virus (HBV) co-infected, compared to HBV mono-infected patients. The study was conducted per a priori defined protocol, including only longitudinal studies, thus excluding cross-sectional studies. Random-effects models were used to determine aggregate effect sizes (ES) with 95% confidence intervals (CI). Meta-regression was used to examine the associations among study level characteristics. Twelve cohort studies comprising a total of 6099 HBV/HDV co-infected and 57,620 chronic HBV mono-infected patients were analysed. The overall pooled ES showed that HBV/HDV co-infected patients were at 2-fold increased risk of HCC compared to HBV mono-infected patients (ES=2.12, 95% CI 1.14-3.95, I2 =72%, N=12). A six-fold significant increased risk of HCC was noted among HIV/HBV/HDV triple-infected, compared to HIV/HBV co-infected patients. The magnitude of ES did not differ significantly after adjustment for study design and quality, publication year and follow-up duration in univariable meta-regression analysis. This systematic review and meta-analysis shows that infection with HDV is associated with a 2-fold higher risk of HCC development compared to HBV mono-infection. HCC surveillance strategies taking this increased risk into account, and new treatment options against HDV, are warranted.

S2425 Pregnancy and Transaminitis in the COVID-19 Era

INTRODUCTION: Liver complications associated with the novel corona virus, COVID-19 (SARS-CoV-2) are well-described phenomena occurring in approximately 60% of infected patients. The degree and extent in the level of transaminitis is not yet well defined. In the evaluation of transaminitis in pregnant patients, consideration of the differential diagnoses is important in order to provide appropriate timely treatment and management. Determining the exact etiology for transaminitis in the pregnant patient with COVID-19 is particularly challenging given other competing diagnosis in this patient population. We present a case of a pregnant woman with acute liver enzyme elevation in the setting of COVID-19 infection. CASE DESCRIPTION/METHODS: A 34 year old female with COVID-19 presented at 33 weeks twin gestation with right upper quadrant pain, vomiting for 2 days and acute respiratory distress which improved with supplemental oxygen. Initial labs showed elevated inflammatory markers, mildly elevated liver enzymes (AST 102, ALT 53 IU/L), low platelets (139 K/uL), lactate dehydrogenase was 375 IU/L, and INR was 1.0. Total bilirubin was normal. An abdominal ultrasound demonstrated cholelithiasis without evidence of cholecystitis, patent portal and hepatic veins, and no biliary ductal dilation. The next day, her liver enzymes increased (ALT; 119 IU/L and AST; 228 IU/L), and LDH rose to 750 IU/L while vital signs were unchanged. She was treated with N-acetyl-cysteine (non-acetaminophen-induced liver failure protocol) without improvement. The next day her liver enzymes peaked (ALT; 307 IU/L and AST; 641 IU/L). Due to rising liver enzymes, increased abdominal pain she underwent an emergency c-section to minimize maternal and fetal risk. Post-operatively, her ALT and AST down trended. On post-op day 4, aminotransferases markedly improved (AST of 20 IU/L, ALT of 49 IU/L), patients symptoms improved and patient was discharged home. DISCUSSION: Clinical presentation and associated liver complications of COVID-19 infection are not well described. Due to the rapid global spread of COVID-19, prompt identification of associated liver test abnormalities from other causes especially in pregnant patients is vital. It is also important to consider that COVID-19 may cause severe acute viral hepatitis rather than a mild elevation in liver enzymes in pregnant patients, possibly exacerbating underlying conditions such as pre-eclampsia or HELLP syndrome.Figure 1.: Graph Trending AST, ALT, LDH throughout Hospital Stay.Table 1.: Chart of Common Hepatic Complications in Pregnancy.

Study on the expression of fibrinogen-like protein 2 during recovery period in liver tissues of patients with severe viral hepatitis B

收集2012年5月-2016年5月收治的重型乙型肝炎恢复期患者（重肝组）和慢性乙型肝炎患者（慢肝组）共57例。重肝组分重肝无肝硬化组和重肝伴肝硬化组，慢肝组分慢肝轻度组和慢肝重度组。免疫组织化学法分析肝组织凝血酶原酶（FGL2）的表达，将其与患者肝脏病理变化、肝功能、凝血酶原活动度行相关性分析，并比较重肝组和慢肝组以及各组间FGL2的表达。结果示重肝组肝组织病理相当于以G3-4 S3-4为主，存在坏死后明显的肝纤维化或坏死后的肝硬化，且肝组织炎症及纤维化同时表现。FGL2在重型乙型肝炎恢复期高表达，与并发肝硬化正相关。.

Clinical Significance of AFP, HGF and Micro RNA-122 Levels in Patients with Liver Cirrhosis and Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and is advanced by severe viral hepatitis B or C (HBV or HCV). HCC is frequently diagnosed late requiring costly surgical resection or transplantation. Alpha fetoprotein (AFP) measurements, together with ultrasound are the most non-invasive methods for detection of HCC. Also, serum levels of hepatocyte growth factor (HGF) vary in liver diseases, reflecting hepatic damage and hepatocellular dysfunction. The discovery of miRNAs circulating in the peripheral blood has opened new directions of research to identify new non-invasive markers for diagnosis of diseases . Objectives: To assess the serum level of HGF and AFP in patients with liver cirrhosis with HCV infection and those of HCC .Also, to evaluate the expression levels of circulating plasma miRNA-122 in Egyptian patients. Methodology: Anti-HCV and HCV RNA were detected by an enzyme immunoassay and the viral RNA mini kit respectively among patients with cirrhosis and HCC. Also, serum AFP and HGF concentration was measured by sandwich ELISA for patients with HCC, patients with cirrhosis and normal controls. Correlation between HGF levels AFP and biochemical (transaminases, prothrombin activity, albumin, bilirubin), or virological (hepatitis C virus load) parameters was analyzed. . Expression level of miRNA-122 in plasma using RT-PCR were determined. Results: The serum AFP level was significantly elevated in cirrhotic and HCC patients in comparison to the control, with the highest level in the HCC group. On the other hand, the HGF level was significantly higher in HCC group than patients with cirrhosis. For HGF, the sensitivity and specificity were better than AFP (95% and 80% respectively). MiRNA-122 showed significant elevation in patients with cirrhosis groups and HCC group (P = 0.001) in comparison to the control group. Receiver operator characteristic (ROC) curve analysis for miRNA-122 yielded 73% sensitivity and 96 % specificity for the differentiation of HCC patients from non-HCC at a cutoff 0.165. Conclusion: HGF was better than AFP as noninvasive biomarkers for the detection of HCC in HCV cirrhotic patients. As its specificity was 96 %. MiRNA-122 can be used as novel non-invasive biomarker for monitoring HCV related disease progression.

Efficacy and safety of Kuhuang injection in treating viral hepatitis： systematic review and Meta-analysis of randomized controlled trials

To systematically evaluate the effectiveness and safety of Kuhuang injection in treating viral hepatitis. Eight electronic databases and clinic trials were searched to collect randomized controlled trials for the effect of Kuhuang injection in the treatment of viral hepatitis. According to the Cochrane Handbook 5.1, two independent reviewers screened out the literatures, extracted data and assessed the quality of thestudies included. RevMan5.3 software was used for the data analysis. A total of 32 articles were included, involving 3 188 patients, including male 1 951 cases (61.2%), female 859 cases (26.9%), and 378 cases of unknown sex (11.9%). All the clinical studies showed a low quality. Due to the complication of diseases and difficulty in intervention measures, most trails were classified by the condition of diseases, and then a descriptive analysis was made. The results showed that the test group was better than the control group in total efficiency of treating severe icteric viral hepatitis, and the test group was advantageous over the control group in jaundice removal and liver function recovery rate in treating icteric hepatitis. In the Meta-analysis on the RCTs for icteric viral hepatitis, the total efficiency of Kuhuang injection + comprehensive treatment group was higher than that of the comprehensive treatment group （RR=1.35, 95%CI=[1.10,1.66], P=0.61）. In addition, when Kuhuang injection was dripped too fast, patients had such adverse reactionsas dizziness, palpitation, nausea, vomiting and skin rash, which could be relieved at a lower dripping speed.Based on the existing evidences, Kuhuang injection had a certain effect in treating viral hepatitis. Most clinic trails did not include viral hepatitis etiology, clinical classification and diversified intervention measures, which resulted in a high clinical heterogeneity and poor comparability between trails. Besides, most trials had a low methodological quality, which affected the authenticity of the results. Therefore, more high-quality, multi-center, large-sample, randomized double-blind controlled trialsarerequired to prove the evidences.

Pharmacological interventions for acute hepatitis B infection: an attempted network meta-analysis.

Pharmacological interventions for acute hepatitis B infection: an attempted network meta-analysis.

A new understanding of etiological treatment in patients with severe viral hepatitis

A new understanding of etiological treatment in patients with severe viral hepatitis

Micro RNAs mir-106a, mir-122 and mir-197 are increased in severe acute viral hepatitis with coagulopathy.

The severity of acute viral hepatitis, which may be caused by several distinct viruses, varies among individual patients. In rare cases, severe hepatic injury with sudden loss of liver function may occur, which is clinically indicated by the occurrence of coagulopathy or encephalopathy. As the molecular mechanisms of this liver injury are largely unknown, we investigated extracellular micro RNA (miRNA) profiles in 54 patients acutely infected with one of four different hepatotropic viruses, in order to identify those miRNAs which indicate severe viral hepatitis associated with coagulopathy. First, the profile of miRNAs was extensively analysed using a microarray-based approach in highly characterized 24 patients, matched in terms of sex, age and level of liver enzymes, as well as in three healthy controls. The cohort included samples from 18 patients with moderate and six individuals with severe hepatitis, indicated by abnormal prothrombin time and higher alanine aminotransferase and bilirubin levels. miRNAs found to be upregulated in severe hepatitis were then quantified by real-time PCR in the expanded cohort of 54 patients. Comprehensive microarray-based miRNA profiling identified upregulation of mir-106a, mir-122 and mir-197 in patients with severe acute viral hepatitis with coagulopathy, as compared to patients who did not develop coagulopathy. mir-106a, mir-122 and mir-197 were then proven to be significantly upregulated in patients with severe acute viral hepatitis by quantitative real-time PCR (P < 0.01, Mann-Whitney U-test). mir-106a, mir-122 and mir-197 could be potential markers for severe acute viral hepatitis associated with coagulopathy.

P049: Micro RNAs miR‐106a, miR‐122 and mir‐197 are increased in severe acute viral hepatitis with coagulopathy

Journal of Viral HepatitisVolume 22, Issue S2 p. 43-44 Poster PresentationFree Access P049: Micro RNAs miR-106a, miR-122 and mir-197 are increased in severe acute viral hepatitis with coagulopathy First published: 25 June 2015 https://doi.org/10.1111/jvh.47_12425AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS2Special Issue: 15th International Symposium on Viral Hepatitis and Liver Diseases (ISVHLD) held from June 26th to 28th, 2015, in Berlin, GermanyJune 2015Pages 43-44 RelatedInformation

Effect of famciclovir combined with oxymatrine on T lymphocyte subsets in patients with chronic severe viral hepatitis B

Effect of famciclovir combined with oxymatrine on T lymphocyte subsets in patients with chronic severe viral hepatitis B

Usefulness of B-mode and doppler sonography for the diagnosis of severe acute viral hepatitis A.

To investigate B-mode and Doppler ultrasonography (US) features correlating with laboratory findings for the diagnosis of severe acute hepatitis (SAH) in patients with hepatitis A virus infection. Thirty-nine consecutive serologically proven patients were enrolled. Decreased parenchymal echotexture, periportal tracking, gallbladder wall change, and splenomegaly were assessed on B-mode images. Blood flow velocities were measured in the main portal (V(PORTAL)) and in the hepatic veins, and the hepatic venous pulsatility index was calculated. SAH was defined as high model for end-stage liver disease (MELD) score ≥ 15 with or without coagulopathy. The relationship between US features and laboratory findings was assessed, and SAH diagnosis was evaluated. Serum alanine transaminase and prothrombin time were significantly different depending on the presence of gallbladder wall change and splenomegaly (p < 0.05). V(PORTAL) was inversely correlated with MELD score (r = -0.485) and several laboratory markers. The hepatic venous waveform and hepatic venous pulsatility index were significantly correlated with MELD score. For the diagnosis of SAH, the area under the receiver operating characteristic curve of V(PORTAL) was 0.798. It reached 0.869 in the patients with typical GB change. Both B-mode and Doppler US correlated well with several laboratory variables and may be helpful to diagnose SAH in patients with hepatitis A virus infection.

Glucocorticoids can increase the survival rate of patients with severe viral hepatitis B

Severe viral hepatitis B is a disease associated with significant morbidity and mortality. Clinical controlled trials show that the efficacy of treatment of severe viral hepatitis B with glucocorticoids remains debatable. Therefore, we carried out this meta-analysis to evaluate the safety, efficacy, and side effects of glucocorticoid therapy for severe viral hepatitis B. We searched PubMed, Medline, Embase, Cochrane Library, and Google Scholar for randomized-controlled trials published before April 2012 in which glucocorticoid therapy was compared with routine treatment for severe viral hepatitis B. The primary outcome was the survival rate of the two groups. We selected eight controlled clinical trials, which included 597 patients. We recorded a benefit of glucocorticoid treatment on the survival rate of patients with severe viral hepatitis B (597 patients) [risk ratio (RR)=1.188, 95% confidence interval (CI) 1.030-1.369, P=0.018]. The benefit was most noticeable in patients at the stage of preliver failure (409 patients) (RR=1.275, 95% CI 1.077-1.510, P=0.005), whereas there was no efficacy for patients with liver failure (188 patients) (RR=1.008, 95% CI 0.774-1.312, P=0.955). Glucocorticoid treatment was not associated with the development of secondary infection and bleeding. Treatment with glucocorticoids can significantly increase the survival rate of patients with severe hepatitis B. The benefit was most noticeable in patients at the stage of preliver failure. However, the incidence of secondary infection and bleeding did not change significantly. This finding suggests that prompt and timely glucocorticoid treatment is crucial.