Predictors of mortality in a large cohort of patients with acute hepatitis in a Low Middle-Income Country.

Background. In developing countries, acute hepatitis poses a serious threat in terms of mortality and morbidity. Objective: The aim of our study was to assess the etiology, clinical, and biochemical profile of acute hepatitis patients and study the predictors of mortality. Patient and Methods. A retrospective study was conducted from records over 3 years in an infectious disease facility. The data on etiology, clinical presentation, complications, severity, and outcomes were collected. Univariate followed by multivariate analysis was done to derive the predictors of mortality. Results. A total of 2488 patients were included. Hepatitis E was the most common etiology (52.65%), followed by hepatitis A (22.18%) and hepatitis B (10.56%). The majority of patients with hepatitis C (68.9%) had cirrhosis. The overall mortality rate was 1.43% among patients with viral hepatitis. Altered sensorium, gastrointestinal bleeding, anemia, elevated bilirubin, low albumin, and presentation as acute liver failure (ALF) or acute on chronic liver failure (ACLF) were independent predictors of mortality. Among patients of autoimmune hepatitis (AIH), one-third had age>60 years and the majority (83.9%) had cirrhosis. Drug-induced liver injury (DILI) was the most prevalent etiology among non-viral causes. The most common offending drug was complementary medications. Patients with non-A/non-E hepatitis were older and had higher mortality than hepatitis A/E patients. Conclusion. Hepatitis E is still the most prevalent cause of acute hepatitis. ALF/ACLF presentation and related comorbidities, such as altered sensorium and GI bleeding, predict death. [ABSTRACT FROM AUTHOR]