Skip to main content

Advertisement

SpringerLink
Log in

Gender Impacts on the Disease Severity of Overt Acute Hepatitis A: Different from Overt Acute Hepatitis B

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Acute hepatitis A (AH-A) and acute hepatitis B (AH-B) were found more severe in males and females, respectively, while impacts from underlying liver disease on severity were not excluded in the AH-A study.

Aim

The precise gender-specific impact on the severity of AH-A was investigated and compared with that of AH-B.

Methods

A case–control study of overt AH-A (n = 118) and AH-B (n = 118) patients without any underlying liver disease was conducted. Overt hepatitis was defined as serum bilirubin ≥ 2 mg/dL and alanine transaminase (ALT) ≥ 10 × upper limit of normal.

Results

Of the AH-A patients, age (95% confidence interval of odds ratio 1.051–1.147) and ALT (1.001–1.002) were associated with hepatic decompensation. Indifferent rates of hepatic decompensation, hepatic failure, and mortality were found between male and female patients. Compared with the AH-B patients, AH-A patients showed lower bilirubin levels (p < 0.001), hepatic decompensation (p = 0.004), and mortality rates (p = 0.013). Among patients < 40 years, the AH-A patients had higher hepatic decompensation rates than AH-B in the male subgroup (15% vs. 2.8%, p = 0.045), while the situation is reverse in the female subgroup (7.7% vs. 48.1%, p = 0.001).

Conclusions

Overt AH-A was less severe than overt AH-B and, unlike AH-B, had no difference in severity between males and females. Among subgroups < 40 years, AH-A was more severe than AH-B in males, but the situation was reverse in females in terms of hepatic decompensation rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carrillo-Santisteve P, Tavoschi L, Severi E, et al. Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic Area: a systematic review. Lancet Infect Dis. 2017. https://doi.org/10.1016/s1473-3099(17)30392-4.

  2. Kim JI, Kim YS, Jung YK, et al. Factors influencing the severity of acute viral hepatitis A. Korean J Hepatol. 2010;16:295–300.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yoo SH, Kim IH, Jang JW, et al. Clinical features and risk factors for severe complications among patients with acute hepatitis A virus infection in the Jeonbuk Province of Korea. Korean J Gastroenterol. 2014;63:25–31.

    Article  PubMed  Google Scholar 

  4. Lee HW, Chang DY, Moon HJ, et al. Clinical factors and viral load influencing severity of acute hepatitis A. PLoS ONE. 2015;10:e0130728.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Becker U, Deis A, Sørensen TI, et al. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology. 1996;23:1025–1029.

    Article  CAS  PubMed  Google Scholar 

  6. Reuben A, Koch DG, Lee WM, et al. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology. 2010;52:2065–2076.

    Article  PubMed  Google Scholar 

  7. Fish EN. The X-files in immunity: sex-based differences predispose immune responses. Nat Rev Immunol. 2008;8:737–744.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Klein SL. Sex influences immune responses to viruses, and efficacy of prophylaxis and treatments for viral diseases. Bioessays. 2012;34:1050–1059.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Chang ML, Liaw YF. Overt acute hepatitis B is more severe in female patients. Hepatology. 2017;66:995–996.

    Article  PubMed  Google Scholar 

  10. Chen CM, Chen SC, Yang HY, et al. Hospitalization and mortality due to hepatitis A in Taiwan: a 15-year nationwide cohort study. J Viral Hepat. 2016;23:940–945.

    Article  PubMed  Google Scholar 

  11. Chang ML, Jeng WJ, Liaw YF. Clinical events after cessation of lamivudine therapy in patients recovered from hepatitis B flare with hepatic decompensation. Clin Gastroenterol Hepatol. 2015;13:979–986.

    Article  CAS  PubMed  Google Scholar 

  12. Tsai SH, Chang HM, Hsieh CB, et al. Acute fulminant hepatitis B in a patient with diabetic nephropathy treated successfully with concomitant lamivudine and molecular adsorbents recirculating system. J Infect. 2006;53:e19–e23.

    Article  PubMed  Google Scholar 

  13. Sampliner RE, Woronow DI, Alter MJ, et al. Community-acquired non-A, non-B hepatitis: clinical characteristics and chronicity. J Med Virol. 1984;13:125–130.

    Article  CAS  PubMed  Google Scholar 

  14. Chu CM, Sheen IS, Liaw YF. The etiology of acute hepatitis in Taiwan: acute hepatitis superimposed upon HBsAg carrier state as the main etiology of acute hepatitis in areas with high HBsAg carrier rate. Infection. 1988;16:233–237.

    Article  CAS  PubMed  Google Scholar 

  15. Chu CM, Liaw YF. The incidence of fulminant hepatic failure in acute viral hepatitis in Taiwan: increased risk in patients with pre-existing HBsAg carrier state. Infection. 1990;18:200–203.

    Article  CAS  PubMed  Google Scholar 

  16. Reiss G, Keeffe EB. Review article: hepatitis vaccination in patients with chronic liver disease. Aliment Pharmacol Ther. 2004;19:715–727.

    Article  CAS  PubMed  Google Scholar 

  17. Rakela J, Redeker AG, Edwards VM, et al. Hepatitis A virus infection in fulminant hepatitis and chronic active hepatitis. Gastroenterology. 1978;74:879–882.

    Article  CAS  PubMed  Google Scholar 

  18. Mathiesen LR, Skinoj P, Nielsen JO, et al. Hepatitis type A, B, and non-A non-B in fulminant hepatitis. Gut. 1980;21:72–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gimson AE, White YS, Eddleston AL, et al. Clinical and prognostic differences in fulminant hepatitis type A, B and non-A non-B. Gut. 1983;24:1194–1198.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Okuno T, Sano A, Deguchi T, et al. Pathology of acute hepatitis A in humans. Comparison with acute hepatitis B. Am J Clin Pathol. 1984;81:162–169.

    Article  CAS  PubMed  Google Scholar 

  21. Tsui JI, Mirzazadeh A, Hahn JA, et al. The effects of alcohol on spontaneous clearance of acute hepatitis C virus infection in females versus males. Drug Alcohol Depend. 2016;169:156–162.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. van Lunzen J, Altfeld M. Sex differences in infectious diseases-common but neglected. J Infect Dis. 2014;209:S79–S80.

    Article  CAS  PubMed  Google Scholar 

  23. Grebely J, Page K, Sacks-Davis R, et al. The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology. 2014;59:109–120.

    Article  CAS  PubMed  Google Scholar 

  24. Burguete-Garcia AI, Conde-Gonzalez CJ, Jimenez-Mendez R, et al. Hepatitis C seroprevalence and correlation between viral load and viral genotype among primary care clients in Mexico. Salud Publica Mex. 2011;53:S7–S12.

    PubMed  Google Scholar 

  25. Westreich D. Berkson’s bias, selection bias, and missing data. Epidemiology. 2012;23:159–164.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors thank Ms Shu-Chun Chen for her data mining assistance and Ms. Su-Chiung Chu for assistance in preparing the article. Part data of the patients with AH-B had been published in Hepatology, 2017;66:995–996. This study was supported by grants from the Chang Gung Medical Research Program (CMRPG1G0061, CMRPG1G0062) and the National Science Council, Taiwan (106-2314-B-182-041-MY2).

Author information

Author notes

  1. Ming-Ling Chang and Yun-Fan Liaw contributed equally.

Authors and Affiliations

  1. Chang Gung University College of Medicine, Taoyuan, Taiwan

    Ming-Ling Chang & Yun-Fan Liaw

  2. Liver Research Unit, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No 5, Fu Hsing Street, Kuei Shan, Taoyuan, Taiwan

    Ming-Ling Chang & Yun-Fan Liaw

Authors
  1. Ming-Ling Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yun-Fan Liaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ming-Ling Chang.

Ethics declarations

Conflict of interest

None.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 51 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, ML., Liaw, YF. Gender Impacts on the Disease Severity of Overt Acute Hepatitis A: Different from Overt Acute Hepatitis B. Dig Dis Sci 64, 570–575 (2019). https://doi.org/10.1007/s10620-018-5340-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5340-9

Keywords

Search

Navigation