Hepatitis E virus is a leading cause of acute-on-chronic liver disease: experience from a tertiary centre in Bangladesh.

BACKGROUND: Acute-on-chronic liver failure (ACLF) is common in Bangladesh. Acute viral E hepatitis is sporadically encountered in this country each year, with a rising incidence in the rainy season. This study aimed to identify the etiology of ACLF in Bangladesh. METHODS: In this retrospective study, 69 ACLF patients were included. They presented to our department at the Bangabandhu Sheikh Mujib Medical University in Dhaka. History of diseases was recorded and appropriate investigations were conducted in all patients. RESULTS: Acute hepatitis E virus (HEV) infection was positive in 21.7% (15/69) of the patients, while 14.5% (10/69) had septicemia. Upper gastrointestinal tract hemorrhage was seen in 4.3% of the patients (3/69), while another 4.3% (3/69) had a positive history for alcohol or drugs. None of the patients tested positive for hepatitis A virus infection and no evidence of hepatitis B virus flare was found in any patient. No specific cause for ACLF could be identified. CONCLUSIONS: Acute HEV infection is a leading cause of ACLF in Bangladesh. Many patients were thought to have decompensation of cirrhosis, but subsequently were recognized as having ACLF by a retrospective review according to the definition of the Asian Pacific Association for the Study of the Liver Working Party Meeting on ACLF in New Delhi in early 2008.