3.1 Demographic characteristics
Of the 114 patients, 86 were male (75.44%) and 28 were female (24.56%). The ratio of male to female was 3.07:1. Ages of the patients were from 15 to 90 years (52.35 ± 14.86) and 36 cases (31.58%) were over 60 years old. Thirteen patients were co-infected with hepatitis B virus, 3 patients were co-infected with hepatitis A virus. Eight patients had liver cirrhosis, including 5 patients with alcoholic liver cirrhosis, 2 patients with hepatitis B cirrhosis, and 1 patient with unknown cause. We obtained serum from 41 patients after January 2019, of which 16 were positive for HEV RNA, all of which were confirmed to be genotype 4 by sequencing.
3.2 Incidence of acalculous cholecystitis in patients with acute hepatitis E
Surprisingly, acute acalculous cholecystitis is very common in patients with acute hepatitis E, with a total of 66 positive cases, accounting for 57.89% (95% CI: 48.79%-66.99%). Further, we compared the incidence of cholecystitis by grouping by gender, age, and presence of liver cirrhosis. As shown in Table 1, the incidence of cholecystitis in male patients was significantly higher than female. Although 7 of the 8 patients with liver cirrhosis developed cholecystitis, the incidence rate was as high as 87.5%, while only 55.66% of patients without liver cirrhosis suffered cholecystitis. However, the difference was not statistically significant possibly due to small sample size of patients underlying liver cirrhosis.
Table 1. Incidence of acalculous cholecystitis in various groups.
Group
|
Incidence of Cholecystitis
|
P value
|
Gender
|
|
|
Male(n=86)
|
55/86(63.95%)
|
0.022
|
Female(n=28)
|
11/28(39.29%)
|
|
Liver Cirrhosis
|
|
|
With (n=8)
|
7/8(87.50%)
|
0.079
|
Without (n=106)
|
59/106(55.66%)
|
|
Age
|
|
|
<60y (n=78)
|
42/78(53.85%)
|
0.197
|
≥60y (n=36)
|
24/36(66.67%)
|
|
3.3 Comparison between HE patients with or without acalculous cholecystitis
To further clarify the significance of cholecystitis in hepatitis E, we compared the relevant parameters between the groups with and without cholecystitis. As shown in Table 2, acalculous cholecystitis is more common in male patients with acute hepatitis E. There was no significant difference in the incidence of liver failure and mortality between the two groups. However, the average length of hospital stays for hepatitis E patients with cholecystitis reached nearly 20 days, which was significantly higher than the 12.98 days for patients without cholecystitis. In terms of laboratory indicators, indicators reflecting liver anabolism and reserve function, including albumin, total bile acid, bilirubin, cholinesterase, and prothrombin activity, were significantly inferior in the cholecystitis group to those without cholecystitis. (Table 2)
Table 2. Comparison between the group of patients with and without cholecystitis.
Parameters
|
With Cholecystitis
(n=66)
|
Without Cholecystitis
(n=48)
|
P value
|
Age (years)
|
54.14 ± 15.34
|
49.9 ± 13.97
|
0.133
|
Gender
|
|
|
|
Male (%)
|
55(83.33%)
|
31(64.58%)
|
0.022
|
Female (%)
|
11(16.67%)
|
17(35.42%)
|
|
Hospital days
|
20.12 ± 9.43
|
12.98 ± 7.26
|
<0.001
|
Liver cirrhosis No. (%)
|
7(10.61%)
|
1(2.08%)
|
0.079
|
Liver failure No. (%)
|
12(18.18%)
|
6(12.50%)
|
0.411
|
Death No. (%)
|
5(7.58%)
|
1(2.08%)
|
0.195
|
Spontaneous peritonitis No. (%)
|
6(9.09%)
|
0(0%)
|
0.032
|
Upper gastrointestinal hemorrhage No. (%)
|
2(3.03%)
|
1(2.08%)
|
0.755
|
Hepatic encephalopathy No. (%)
|
1(1.52%)
|
1(2.08%)
|
0.820
|
Hepatorenal syndrome No. (%)
|
2(3.03%)
|
0(0%)
|
0.224
|
ALB(g/L)
|
30.58 ± 4.79
|
35.65 ± 4.27
|
<0.001
|
TBA(mmol/L)
|
171.66 ± 141.74
|
83.37 ± 94.02
|
<0.001
|
TB(mmol/L)
|
|
102.07 ± 87.47
|
<0.001
|
DB(mmol/L)
|
204.12 ± 122.47
|
82.54 ± 76.72
|
<0.001
|
ALT(U/L)
|
1670.84 ± 1297.83
|
1614.60 ± 1716.71
|
0.842
|
AST(U/L)
|
1290.40 ± 1138.70
|
1151.55 ± 1536.80
|
0.580
|
ALP(U/L)
|
213.02 ± 79.89
|
194.20 ± 97.37
|
0.26
|
GGT(U/L)
|
268.60 ± 274.15
|
286.76 ± 245.50
|
0.716
|
LDH(U/L)
|
710.05 ± 716.46
|
613.07 ± 558.51
|
0.448
|
CHE(U/L)
|
3836.86 ± 1426.02
|
5674.67 ± 2088.57
|
<0.001
|
BUN(mmol/L)
|
6.66 ± 6.19
|
5.17 ± 1.69
|
0.112
|
Cr(mmol/L)
|
80.78 ± 55.79
|
71.57 ± 24.13
|
0.291
|
PTA(%)
|
74.72 ± 24.51
|
88.87 ± 25.46
|
0.003
|
TC(mmol/L)
|
3.57 ± 1.11
|
4.43 ± 1.86
|
0.037
|
TG(mmol/L)
|
2.45 ± 1.37
|
1.69 ± 0.97
|
0.030
|
LDL(mmol/L)
|
1.45 ± 0.98
|
2.45 ± 1.29
|
0.002
|
ALB albumin, TBA total bile acid, TB total bilirubin, DB direct bilirubin, ALT alanine aminotransferase, AST aspartate aminotransferase, ALP alkaline phosphatase, GGT gamma-glutamyltransferase, LDH lactate dehydrogenase, CHE cholinesterase, BUN blood urea nitrogen, Cr creatinine, PTA prothrombin activity, TC total cholesterol, TG triglyceride, LDL low density lipoprotein