Expanded Diagnostic Approach to Hepatitis E Virus Detection in Patients with Acute-on-Chronic Liver Failure: A Pilot Study

• Published in: Indian journal of medical microbiology 2018-07, Vol.36 (3), p.391-396
• Main Authors: Steve, Runal John, Gnanadurai, Fletcher John, Anantharam, Raghavendran, Jeyaseelan, Visalakshi, Zachariah, Uday George, Goel, Ashish, Chundamannil, Eapen Eapen, Abraham, Priya
• Format: Article
• Language: English
• Subjects: Acute-on-chronic liver failure; Alcohols; antigen detection enzyme-linked immunosorbent assay; Antigens; Diagnostic systems; Enzyme-linked immunosorbent assay; Ethanol; Genotype & phenotype; Hepatitis; hepatitis E virus; Illnesses; Immunoglobulin M; Industrialized nations; Infections; Informed consent; Laboratories; Liver; Liver failure; Mortality; Patients; Polymerase chain reaction; Proteins; Ribonucleic acid; RNA; Studies; Transplants & implants; Vaccination; Viremia; Viruses
• ISSN: 0255-0857; 1998-3646
• DOI: 10.4103/ijmm.IJMM_18_35

Introduction: Acute decompensation of pre-existing chronic liver disease (CLD), known as acute-on-chronic liver failure (ACLF), is associated with high mortality. Hepatitis E virus (HEV) as a potential cause was studied. Objectives: The objectives of this study are to evaluate the role of HEV in ACLF patients using an IgM anti-HEV antibody enzyme-linked immunosorbent assay (ELISA), HEV antigen ELISA, and a quantitative HEV polymerase chain reaction (PCR). Materials and Methods: In this prospective cross-sectional study, blood samples were collected from 50 ACLF (cases) as defined by the standard guidelines (APASL, 2014) and 50 patients with stable CLD (controls) from January 2015 to August 2016, after obtaining informed consent. Two IgM ELISAs (MP Diagnostics HEV IgM ELISA 3.0, Singapore and Wantai HEV IgM ELISA, Beijing, China) were compared using plasma from cases and controls. In addition, an HEV antigen detection by ELISA (Wantai, Beijing, China) and a real-time PCR for quantification of HEV RNA in plasma and stool were employed. Results: Ethanol was the leading cause of acute insult in ACLF (54%) cases. HEV infection accounted for 20% of cases. Ten ACLF patients (20%) had 1–3 markers of HEV versus two (4%) among controls (P = 0.0138). Among ACLF cases, one had HEV viraemia (403 IU/ml), faecal shedding (2790 IU/ml) and detectable HEV antigenaemia. Agreement between the two anti-HEV IgM ELISAs was 0.638 (kappa value). Conclusion: This study shows that alcohol is a major contributing factor for both underlying CLD and ACLF while HEV is the most common infectious cause for ACLF, suggesting a need for a vaccination in such patients, whenever made available.