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Clinical Observation |

Hepatic Decompensation in Patients With Cirrhosis During Infection With Influenza A

Andrea Duchini, MD; M. Eric Viernes, MD; Lisa M. Nyberg, MD; R. Michael Hendry, DSc; Paul J. Pockros, MD
Arch Intern Med. 2000;160(1):113-115. doi:10.1001/archinte.160.1.113.
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Background  Patients with chronic liver disease can develop hepatic decompensation during systemic infections. Although gram-negative and gram-positive bacteria are well recognized as causes of decompensation, the effect of influenza virus infection on patients with chronic liver disease is poorly documented.

Methods  Retrospective analysis of patients with positive viral cultures who were seen at a liver transplantation clinic in a tertiary care referral center during the 1997-1998 influenza A (H3N2) epidemic in San Diego, Calif.

Results  Three patients with end-stage liver disease (1 with Wilson disease and 2 with alcoholic liver disease) developed hepatic decompensation and required hospitalization during infection with influenza A. Two patients had biochemical and clinical evidence of hepatic decompensation, including ascites, hepatic encephalopathy, and peripheral edema, and the third had acute hepatocellular damage, with elevated levels of aminotransferases. Viral hepatitis serologic test results, acetaminophen levels, drug and alcohol screening findings, and bacterial and fungal cultures were negative in all 3 patients. Hepatic decompensation resolved without the need for transplantation in the 2 patients with liver failure, and all patients recovered to their baseline liver function levels within 1 month of onset of acute illness.

Conclusions  Influenza A infection can cause hepatic decompensation and hospitalization in patients having cirrhosis or who are awaiting liver transplantation. Effective prevention with vaccination and early recognition and treatment of influenza are strongly recommended in these individuals.

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The 1997-1998 California influenza epidemic and the isolated viral subtypes and strains. Epidemic peaked in late December 1997, and early January 1998. Presentation of the 3 patients we describe is also indicated. The 1997 vaccine was poorly protective because of the appearance of the new strain A/Sydney/05/97, which represented a major antigenic drift in the influenza A virus. Most cases of influenza, including the patients we describe, were caused by this viral strain. Three patients we describe were not vaccinated that year.

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