Systematic review of the global epidemiology of viral-induced acute liver failure

Jenna Patterson; Hannah Sophia Hussey; Sheetal Silal; Liz Goddard; Mashiko Setshedi; Wendy Spearman; Gregory D Hussey; Benjamin M Kagina; Rudzani Muloiwa

doi:10.1136/bmjopen-2020-037473

Systematic review of the global epidemiology of viral-induced acute liver failure

BMJ Open. 2020 Jul 20;10(7):e037473. doi: 10.1136/bmjopen-2020-037473.

Authors

Jenna Patterson¹, Hannah Sophia Hussey², Sheetal Silal^{3

4}, Liz Goddard⁵, Mashiko Setshedi⁶, Wendy Spearman⁷, Gregory D Hussey^{2

8}, Benjamin M Kagina², Rudzani Muloiwa^{2

9}

Affiliations

¹ Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa PTTJEN005@myuct.ac.za.
² Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.
³ Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
⁴ Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK.
⁵ Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
⁶ Department of Medicine, Division of Gastroenterology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
⁷ Department of Medicine, Division of Hepatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
⁸ Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.
⁹ Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

Abstract

Objectives: The aetiology and burden of viral-induced acute liver failure remains unclear globally. It is important to understand the epidemiology of viral-induced ALF to plan for clinical case management and case prevention.

Participants: This systematic review was conducted to synthesize data on the relative contribution of different viruses to the aetiology of viral-induced acute liver failure in an attempt to compile evidence that is currently missing in the field. EBSCOhost, PubMed, ScienceDirect, Scopus and Web of Science were searched for relevant literature published from 2009 to 2019. The initial search was run on 9 April 2019 and updated via PubMed on 30 September 2019 with no new eligible studies to include. Twenty-five eligible studies were included in the results of this review.

Results: This systematic review estimated the burden of acute liver failure after infection with hepatitis B virus, hepatitis A virus, hepatitis C virus, hepatitis E virus, herpes simplex virus/human herpesvirus, cytomegalovirus, Epstein-Barr virus and parvovirus B19. Data were largely missing for acute liver failure after infection with varicella-zostervirus, human parainfluenza viruses, yellow fever virus, coxsackievirus and/or adenovirus. The prevalence of hepatitis A-induced acute liver failur was markedly lower in countries with routine hepatitis A immunisation versus no routine hepatitis A immunisation. Hepatitis E virus was the most common aetiological cause of viral-induced acute liver failure reported in this review. In addition, viral-induced acute liver failure had poor outcomes as indicated by high fatality rates, which appear to increase with poor economic status of the studied countries.

Conclusions: Immunisation against hepatitis A and hepatitis B should be prioritised in low-income and middle-income countries to prevent high viral-induced acute liver failure mortality rates, especially in settings where resources for managing acute liver failure are lacking. The expanded use of hepatitis E immunisation should be explored as hepatitis E virus was the most common cause of acute liver failure.

Registration: PROSPERO registration number: CRD42017079730.

Keywords: epidemiology; hepatology; virology.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cytomegalovirus
Epstein-Barr Virus Infections*
Herpesvirus 4, Human
Humans
Liver Failure, Acute* / epidemiology
Liver Failure, Acute* / etiology
Virus Diseases*