Acute liver failure (ALF) due to hepatitis A virus (HAV) infection is an uncommon but potentially lethal illness. The aim of this study was to identify readily available laboratory and clinical features associated with a poor prognosis among ALF patients with HAV infection. The presenting features of 29 adults with anti-HAV IgM positive ALF enrolled in the ALFSG between 1998 and 2005 were reviewed. The HAV patients listed for transplantation by UNOS were also reviewed. Acute HAV accounted for 3.1% of patients enrolled in the ALFSG. At 3 weeks follow-up, 16 had spontaneously recovered (55%), 9 underwent transplantation (31%), and 4 had died (14%). A prognostic model incorporating 4 presenting features (serum ALT <2,600 IU/L, creatinine >2.0 mg/dL, intubation, pressors) had an AUROC for transplant/death of 0.899 which was significantly better than the King's College criteria (0.623, P โซุโฌ .018) and MELD scores (0.707, P โซุโฌ .0503). Between 1988 and 2005, the frequency of patients requiring liver transplantation for HAV in the UNOS database significantly decreased from 0.7 % to 0.1% (P < .001). In addition, the proportion of HAV cases enrolled in the ALFSG significantly decreased from 5% to 0.8% (P โซุโฌ .007). In conclusion, the frequency of HAV patients enrolling in the ALFSG and being listed for liver transplantation in the United States has declined in parallel. A prognostic index consisting of 4 clinical and laboratory features predicted the likelihood of transplant/death significantly better than other published models suggesting that disease specific prognostic models may be of value in non-acetaminophen ALF. (HEPATOLOGY 2006;44:1589-1597.) See Editorial on Page 1397
O ver the past 20 years, the Centers for Disease Control and Prevention (CDC) have reported a significant decline in the incidence of acute hepatitis A virus (HAV) infection in the United States. 1,2 However, sporadic outbreaks of HAV infection continue to be reported largely due to enteral spread of contaminated food or direct person-to-person contact. 3,4 Al-though the majority of immunocompetent adults exposed to HAV experience an acute self-limited illness, the likelihood of developing symptomatic hepatitis with jaundice appears to be greater in adults compared to children and the rates of hospitalization and complications appear to be highest in the elderly. [5][6][7] Since recent studies have demonstrated a decreasing incidence of protective immunity to HAV among adults in western countries, the potential for severe morbidity and mortality during spo-