ORIGINAL ARTICLE   

Minerva Medica 2020 August;111(4):330-6

DOI: 10.23736/S0026-4806.19.06331-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Changing epidemiology of acute liver failure in Italy: a single-center experience over 25 years

Pietro AMOROSO ¹ ✉, Salvatore BUONOCORE ¹, Gennaro LETTIERI ¹, Gaetano PESCE ¹, Paola PIERRI ¹, Raffaele DE SENA ¹, Giuseppe MORELLI ¹, Bianca MATTEIS ¹, Chiara DELL’ISOLA ¹, Valeria DE MARINO ¹, Anna R. CICCAGLIONE ², Rodolfo PUNZI ¹, Ciro ESPOSITO ³, Enea SPADA ²

¹ Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy; ² Department of Infectious Diseases, National Institute of Health, Rome, Italy; ³ Department of Transplants, A. Cardarelli Hospital, Naples, Italy

BACKGROUND: Acute liver failure (ALF) is a rare but often lethal syndrome. In Italy, recent data on its incidence and causes are lacking. We report here the epidemiological analysis of ALF cases observed in Campania, a Southern Italian region, over the last 25 years.
METHODS: Medical records of ALF cases hospitalized from 1992 to 2018 were retrospectively analyzed.
RESULTS: Two hundred ten ALF cases occurred during 1992-2018: 103 (49%) hepatitis B virus (HBV)-related (including 5 cases also infected with Delta virus), 39 (19%) from undetermined cause, 36 (17%) drug-induced, 11 (5%) Wilson’s disease-associated, 8 (4%) hepatitis A virus (HAV)-related and 12 (6%) from other causes. Separate time-periods analysis of data showed a significant progressive decrease in ALF incidence mainly attributable to a decline of HBV and other viruses etiology. Already before 2010, HAV or Delta virus-related cases have no longer been observed. No hepatitis C or E virus-related ALF was detected through the study period. A progressive decrease in frequency of ALF due to undetermined causes or drug was also evident.
CONCLUSIONS: A decrease in ALF incidence and a changing in its etiology were observed in Campania during 1992-2018. Both results were likely mainly due to 1991 introduction of HBV universal vaccination and may be considered generalizable nationwide.

KEY WORDS: Liver failure, acute; Epidemiology; Italy