Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death

Background/Aims India is hyper-endemic for hepatitis E virus (HEV). HEV infection in cirrhosis may cause high mortality. Prospective study evaluating HEV infection in cirrhotics is scarce. Methods Consecutive patients with cirrhosis and healthy controls were included. Cirrhotics were categorized to 3 groups, (Group I – rapid decompensation, Group II – chronically decompensated, Group III – cirrhotics without decompensation). Sera from cirrhotics and controls were tested for HEV-RNA (RT-PCR). HEV-RNA positivity among cirrhotics and controls was compared. Natural course and mortality rate between HEV infected and non-infected cirrhotics were assessed during a 12-month follow-up. Results 107 cirrhotics and 200 controls were included. 30 (28%) cirrhotics and 9 (4.5%) controls had detectable HEV-RNA (p < 0.001). HEV- RNA positivity among Group I (n = 42), II (n = 32) and III (n = 33) cirrhotics was 21 (50%), 6 (19%) and 3 (10%), respectively (p = 0.002). 70% (21/30) with HEV infection and 27% (21/77) without it had rapid decompensation (p = 0.001). Mortality between HEV infected and non-infected cirrhotics at 4 weeks (43% vs. 22%, p = 0.001) and 12 month (70% vs. 30%, p = 0.001) was different. Multivariate analysis identified HEV infection, Child-Pugh’s score, renal failure, and sepsis as independent factors for mortality. Conclusions In India, cirrhotics were prone to HEV infection, which was associated with rapid decompensation and death.