Role of hepatitis E infection in acute on chronic liver failure in Egyptian patients

Liver Int. 2011 Aug;31(7):1001-5. doi: 10.1111/j.1478-3231.2011.02521.x. Epub 2011 Mar 30.


Background: The vast majority of patients who are referred to a specialist hepatological centre suffer from acute deterioration of their chronic liver disease. Yet, this entity of acute on chronic liver failure remains poorly defined.

Aim: The aim of the present study was to highlight the occurrence of hepatitis E viraemia by nested reverse transcriptase polymerase chain reaction (RT-PCR) in patients with acute on chronic liver failure.

Materials and methods: The study included 100 patients with acute on chronic liver disorders admitted to Mansoura University Hospital, Egypt. Blood samples were obtained from patients and sera were separated. Sera were subjected to a study of viral hepatitis markers for hepatitis A by IgM, for hepatitis B by S antigen and core IgM and for hepatitis C virus by IgG and RT-PCR for HCV. Liver function tests were evaluated including alanine transaminase, aspartate transaminase and bilirubin total and direct by an autoanalyser. Study for hepatitis E virus (HEV) was performed using a molecular technique. Nested RT-PCR was performed for each serum sample.

Results: HEV RNA was detected in the sera of 13 patients (13%) of the patients with chronic liver disorders. The majority of the positive cases were among patients with cirrhosis (29.9%) followed by patients with HCC (15.4%). On multirisk analysis for the factors associated with the presence of HEV viraemia, younger age < 45 years and lower albumin level < 3.5 g/dl were significantly (P = 0.04, P = 0.03) associated with HEV viraemia.

Discussion: From this study it appears that HEV viraemia is a common cause of acute on chronic liver disorders in Egypt.

Conclusion: There is no effective vaccine is available against HEV, mass awareness and preventive measures are important to the related.

MeSH terms

  • Age Factors
  • Alanine Transaminase / blood
  • Aspartate Aminotransferases / blood
  • Bilirubin / blood
  • Biomarkers / blood*
  • Egypt
  • End Stage Liver Disease / blood
  • End Stage Liver Disease / etiology*
  • Hepatitis E / blood
  • Hepatitis E / complications*
  • Hepatitis E virus / genetics*
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Liver Function Tests
  • RNA, Viral / blood
  • Reverse Transcriptase Polymerase Chain Reaction
  • Viremia / genetics


  • Biomarkers
  • Immunoglobulin G
  • Immunoglobulin M
  • RNA, Viral
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Bilirubin