SHM Converge Scientific Abstract ePoster Gallery-Severe Acute Liver Injury: Hepatitis C You Later

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Severe acute liver injury (SALI) is commonly defined as AST or ALT greater than 1,000 with symptoms of acute onset within 26 weeks. Identifying the cause is important for treatment and prognosis. The most common causes include ischemic hepatitis, pancreatobiliary disease, drug-induced liver injury, and acute viral hepatitis.<br /><br />Although acute hepatitis C virus (HCV) was previously thought to be an uncommon cause of SALI, recent studies show it can be a significant contributor to viral cases. One multicenter study found acute HCV accounted for 70% of viral SALI cases and 7% of all SALI cases. A UK cohort found HCV caused 2.7% of all cases and about 22% of viral cases.<br /><br />Diagnosis can be challenging because HCV antibody is often negative for up to 12 weeks after exposure, so it may miss acute infection. Also, HCV antibody remains positive after successful treatment. Therefore, HCV PCR testing should be ordered in patients with SALI who have prior HCV infection or risk factors for reinfection.<br /><br />Reinfection risk is low overall after cure, about 1% over five years, but much higher in high-risk groups such as people who inject drugs, incarcerated individuals, or those with HIV coinfection, where five-year reinfection rates are estimated at 10–15%.<br /><br />Overall, clinicians should keep acute HCV on the differential for SALI, especially when antibody testing is negative or when reinfection is possible.

Asset Subtitle

Ann Marie Kumfer

Meta Tag

Author List Ann Marie Kumfer, Gabe Lupu, John R. Stephens, Nicholas Piazza

Category Clinical Vignettes

Concept Severe Acute Liver Injury

Concept Etiology

Concept Ischemic Hepatitis

Concept Drug-Induced Liver Injury

Concept Acute Viral Hepatitis

Distinguished Non-Finalist

Presenter Organization UNC School of Medicine

Presenting Author Ann Marie Kumfer

Track Adult

Keywords

severe acute liver injury

acute hepatitis C

HCV PCR testing

viral hepatitis

ischemic hepatitis

drug-induced liver injury

acute onset

HCV reinfection

liver enzymes

diagnosis

Severe Acute Liver Injury

Etiology

Ischemic Hepatitis

Drug-Induced Liver Injury

Acute Viral Hepatitis