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Minerva Medica 2020 Jan 20

DOI: 10.23736/S0026-4806.19.06331-6


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, Rome, Istituto Superiore di Sanità, 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 aetiology. 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 aetiology 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: Acute liver failure; Epidemiology; Southern Italy region

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