Hepatitis D Virus Coinfection in Patients with Acute-on-Chronic Liver Failure: Impact on Disease Severity and Survival

Background Acute-on-chronic liver failure (ACLF) poses a significant clinical challenge, and its etiology, including the role of hepatitis B (HBV) and D virus (HDV) coinfection, remains an area of active research.

Methods We conducted a monocentric, retrospective data analysis of patient records, focusing on virological data, disease characteristics, and sociodemographic factors. The cohort included 570 patients admitted to the intensive care unit (ICU) with ACLF from 2015 to 2022. Statistical analyses, including Kaplan-Meier survival curves and a log-rank test, were performed to assess differences in survival among these groups.

Results In our cohort of ACLF patients a subset (n=10) had active HDV coinfection alongside patients with active HBV monoinfection (n=15), HBsAg loss (n=37) and Anti-HBc only (n=8), representing 40% of the patients with replicative HBV infection (n=25). These patients were younger (mean age 55.7 years) and less severe liver disease or ACLF severity as indicated by lower MELD and CLIF-C ACLF scores (mean MELD-Score 16, mean CLIF-C ACLF-Score 38). Kaplan-Meier survival analysis showed a reduced survival time in trend (12 days) between groups (HBsAg loss: 131 days, Anti-HBc only: 58 days, HBV monoinfection: 19 days, Overall mortality: 83 days).

Conclusion Our findings highlight the underrecognized impact of HDV coinfection in patients with ACLF. Despite their comparatively lower severity of underlying liver disease, patients with HDV coinfection face worse survival outcomes. Hence, further research is needed to explore the mechanisms and distinct overrepresentation of HDV coinfections compared to HBV-monoinfected patients.

Publication History

Article published online:
23 January 2024