{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:11:41Z","timestamp":1790395901649,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,9,3]],"date-time":"2019-09-03T00:00:00Z","timestamp":1567468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["31770186"],"award-info":[{"award-number":["31770186"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81802020"],"award-info":[{"award-number":["81802020"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background\/Aims<\/jats:title><jats:p>Hepatitis E virus (HEV) infection has been recognized an important insult of acute or acute\u2010on\u2010chronic liver failure (A(C)LF). This study aimed to identify the incidence, predictors and outcomes of A(C)LF in patients with hepatitis E.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients diagnosed of hepatitis E between 2012 and 2018 in the tertiary hospital were retrospectively and consecutively analysed. Patients with hepatitis E who developed A(C)LF were enrolled as cases (HEV\u2010LF) and controls were randomly selected from those who did not develop liver failure with 1:3 ratio in the same cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight hundred and nine patients were diagnosed with hepatitis E, among which 80 were identified with HEV\u2010related liver failure (HEV\u2010LF) with HEV as the solely acute aetiology of A(C)LF. Sequencing of HEV genome showed genotype (GT) 4 strains in all available serum samples. Hepatitis E patients with cirrhosis underwent higher risk to develop liver failure, compared to non\u2010cirrhotic patients. Hydrothorax, respiratory infections, lower \u03b3\u2010glutamyl transferase, higher lactate dehydrogenase and alpha\u2010foetoprotein were found to be independent predictors of A(C)LF in patients with hepatitis E. The 28\u2010day and 90\u2010day mortality for HEV\u2010LF was 12.86% and 30.36% respectively. Renal injury and lower triglyceride were independent factors associated with 28\u2010day mortality. Lower alanine aminotransferase and higher International normalized ratio were independent predictors of 90\u2010day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with GT4 hepatitis E are at high risk to develop A(C)LF. Different CLD status impacted the incidence of HEV\u2010LF distinctively. The identified variables shall help to identify HEV patients with high risk for developing liver failure and the risk for death.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14221","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T09:34:25Z","timestamp":1566466465000},"page":"2291-2300","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Incidence, predictors and prognosis of genotype 4 hepatitis E related liver failure: A tertiary nested case\u2010control study"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3700-1766","authenticated-orcid":false,"given":"Yijin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pathology and Hepatology the 5<sup>th<\/sup>Medical Centre Chinese people\u2019s Liberation Army General Hospital Beijing 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