Hepatitis E virus genotype 3 is associated with gallstone-related disease

Figures & data

Table 1. Laboratory parameters in patients with and without acute hepatitis E, the maximum value during admission is reported.

Laboratory parameters (normal level)	HEV RNA negative n = 142 median (IQR)	HEV RNA positive n = 6 median (IQR)	p Value
nALT (1)	4.7 (2.5–8.5)	11.3 (6.1–25.8)	.01
nAST (1)	3.4 (1.8–6.7)	9.5 (1.2–18.3)	.79
ALP† (0.6–1.8 µkat/L)	3.7 (2.2–6.0)	3.8 (2.4–11.8)	.67
Bilirubin (5–25 µmol/L)	44 (18–81)	27 (16–88)	.46
CRP (<3 mg/L)	69 (19–149)	17 (5–29)	.02
Temperature (°C)	37.7 (37.2–38.3)	38.0 (37.4–38.3)	.64

†ALP = alkaline phosphatase.

Table 2. The final discharge diagnosis according to the medical records.

Diagnosis	n (%)	HEV clinical cases
Gallstone-related except biliary pancreatitis	66 (45)
Cholecystitis	22
Biliary colic	13	1
Common bile duct stone without cholangitis	21
Common bile duct stone with cholangitis	10
Pancreatitis	28 (19)
Biliary	21	3
Alcohol	2
Other	5
Other
Surgical (acute abdomen, trauma, and abdominal pain)	27 (18)	1
Gastrointestinal malignancy	18 (12)	1
Medical (sepsis, mononucleosis)	5 (3)
Liver disease	4 (3)

Table 3. Surgical procedures performed.

Intervention	n (%)	HEV clinical cases
Cholecystectomy acute	31 (21)	2
Endoscopic retrograde cholangiopancreatography (ERCP)	29 (20)	1
Elective cholecystectomy	22 (15)	2
Other surgery	14 (9)	1
No surgery	52 (35)

Table 4. HEV RNA PCR and anti-HEV serology for the patients with acute hepatitis E.

Patient	A	B	C	D	E	F
HEV RNA	+	+	+	+	+	+
Genotype	HEV3	HEV3	−	−	HEV3	HEV3
Anti-HEV IgM	−	−	−	−	+	−
Anti-HEV IgG	−	−	−	−	(+)	−
Follow up anti-HEV IgG	Not tested	−	−	Not tested	Not tested	Not tested

Table 5. Clinical details for the patients with acute hepatitis E.

Patient	A	B	C	D	E	F
Age/gender	27/Female	29/Female	63/Female	45/Female	83/Female	82/Female
Diagnose	Biliary pancreatitis	Biliary pancreatitis	Biliary pancreatitis	Biliary colic	Bowel obstruction	Pancreatic malignancy
Duration of abdominal pain pre-admission (days)	1	7	1	7	1	14
nALT max	8.0	5.7	6.3	24.0	31.2	14.7
Bilirubin max (µmol/L)	33	40	10	18	20	231
Amylase max (µkat/L)	52.8	5.09	30.2	0.39	0.33	3.68
CRP max (mg/l)	19	5	2	17	17	57
Clinical findings	Gallstones in gallbladder, dilated bile tracts	Gallstones in gallbladder	Gallstones in gallbladder, dilated bile tracts	Gallstones in gallbladder	Small bowel obstruction	Malignant stricture of the common bile duct
Surgery	L.C.† day 3	L.C. day 14	L.C. day 14	L.C. day 6	Laparotomy day 2	ERCP day 4
Hospital stay (days)	5	9	3	4	9	5

^† Laparoscopic cholecystectomy.