Hepatitis E cirrhosis risk tied to acute liver failure in study
Hannover researchers found hepatitis E preceded severe deterioration in many cirrhosis patients and urged more routine testing.
By Priya Raghavan · Science Reporter
3 min read
A hepatitis E cirrhosis study from Hannover Medical School found that infection with the virus was linked to severe liver deterioration in patients who already had scarred liver tissue. The findings matter because hepatitis E often passes unnoticed in healthy people but can be dangerous for people with advanced liver disease, according to the researchers.
The team from Hannover Medical School’s Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology analyzed 249 blood samples from inpatients with liver cirrhosis. The study was published in Liver International.
According to Hannover Medical School, about half of cirrhosis patients with hepatitis E developed acute-on-chronic liver failure, a severe complication. Among those cases, half ended in death or required liver transplantation.
What does hepatitis E mean for cirrhosis patients?
Hepatitis E virus, or HEV, is described by the researchers as the most common cause of acute viral hepatitis worldwide. In people without major health problems, the infection usually clears without symptoms or lasting liver damage, Hannover Medical School said.
For people with cirrhosis, the same infection can add strain to a liver that is already damaged. Cirrhosis is scarring of the liver, and when the organ can no longer perform its usual work, patients can develop complications including abdominal fluid buildup, enlarged veins in the esophagus, impaired consciousness and confusion, according to the research team.
The Hannover group also identified cases of acute liver decompensation, a rapid worsening of cirrhosis. The most severe form can progress to acute liver failure.
Why hepatitis E infections are missed
Hannover Medical School said hepatitis E infections remain underdiagnosed, including in tertiary care hospitals. Lead author Dr. Katja Dinkelborg said clinicians may fail to consider HEV, and testing is not available in every setting.
Detection can also be difficult because some patients arrive after viral RNA is no longer measurable in the blood, even though liver injury is becoming apparent. Dinkelborg said that pattern supports the concern that HEV cases are being missed in cirrhosis patients.
HEV infections are common in Europe, with more than 2 million cases each year, according to Hannover Medical School. In Germany, up to 400,000 people are infected annually with genetically varied HEV strains, often after eating contaminated pork, the school said.
What testing and treatments are being studied
The Hannover researchers called for more awareness among medical staff and more routine testing when HEV is suspected. At Hannover Medical School, Dinkelborg said, clinicians monitor for HEV and test blood for viral RNA where infection is suspected.
The team also examined immune protection in the cirrhosis patients by looking for virus-specific antibodies in blood serum. Only one-third had the relevant immune response, while two-thirds had no HEV antibodies, leaving patients with advanced cirrhosis susceptible to infection, according to Dinkelborg.
There is no officially approved treatment for hepatitis E, Hannover Medical School said, though chronic infections can be treated successfully with the antiviral drug ribavirin. Researchers at Hannover Medical School and TWINCORE are also studying neutralizing antibodies from recovered patients as a possible preventive and therapeutic approach.
Those antibody treatments are not yet ready for routine clinical use. Dinkelborg said the current findings point to a need for passive immunization strategies that could better protect high-risk patients from HEV infection.
This story draws on original reporting from Medical Xpress.