The burden of HEV related acute liver failure in the developing world: a systematic review and meta-analysis

Abstract

Abstract Background Hepatitis E has the potential to progress into HEV related acute liver failure (HEV-ALF), but its burden in the developing world remains unclear. We systematically evaluated the burden of HEV-ALF in these regions regarding the frequency and mortality. Methods A systematic search of the literature was performed utilizing the databases of PubMed, the Cochrane Library, Medline, Embase and Web of Science. Studies in English or Chinese that reported on the burden of HEV-ALF in the developing world were included. Outcomes were pooled with meta-analysis utilizing R software. Estimates were calculated with random-effects models, subgroup analysis and sensitivity analysis were conducted to address heterogeneity. Egger’s test and Begg’s test were performed to assess the publication bias. Results A total of 20 eligible studies were included, the results indicated that the pooled proportion of HEV infection in etiology of acute liver failure was 39.0% (95% CI: 29.0–51.0)in non-pregnant individuals and 65.0% (95% CI: 60.0–71.0) in pregnant females. The incidence of HEV-ALF in HEV infected non-pregnant individuals was 24.0% (95% CI: 15.0–33.0), while in pregnant females, it was 34.0% (95% CI: 27.0–42.0). The mortality of HEV-ALF was 31.0% (95% CI: 20.0–43.0) and 63.0% (95% CI: 46.0–79.0) in non-pregnant individuals and pregnant females, respectively. It must be noted that there were differences across specific countries and population. Conclusions The burden of HEV-ALF in developing countries is heavy, prevention of HEV infection and early recognition of HEV-ALF in high risk regions and population is of great significance.