Acute viral hepatitis A has recently become a major public health problem in Korea, and the incidence of symptomatic hepatitis A is growing rapidly. With improvements in socioeconomic conditions and environmental hygiene, the chances of exposure to hepatitis A virus (HAV) during childhood have decreased and, in turn, the proportion of young adults with positive anti-HAV has significantly decreased. This has led to the incidence of symptomatic acute hepatitis A increasing since the late 1990s. The incidence of serious complications including fulminant hepatic failure and acute kidney injury has also showed an increasing trend. Variation of the genotype of virus isolated from recent hepatitis A patients suggests an inflow of the hepatitis virus from other countries. In this review article, we present the situation and epidemiology of hepatitis A in Korea, and recommend further investigation and policies for vaccination on a national level.
Acute Disease ; Genotype ; Hepatitis A/complications/diagnosis/*epidemiology ; Hepatitis A Antibodies/analysis ; Humans ; Incidence ; Kidney Failure, Acute/etiology ; Liver Failure, Acute/etiology ; Vaccines, Inactivated/pharmacology

BACKGROUND/AIMS: A revised classification system for renal dysfunction in patients with cirrhosis was proposed by the Acute Dialysis Quality Initiative and the International Ascites Club Working Group in 2011. The aim of this study was to determine the prevalence of renal dysfunction according to the criteria in this proposal. METHODS: The medical records of cirrhotic patients who were admitted to Konkuk University Hospital between 2006 and 2010 were reviewed retrospectively. The data obtained at first admission were collected. Acute kidney injury (AKI) and chronic kidney disease (CKD) were defined using the proposed diagnostic criteria of kidney dysfunction in cirrhosis. RESULTS: Six hundred and forty-three patients were admitted, of whom 190 (29.5%), 273 (42.5%), and 180 (28.0%) were Child-Pugh class A, B, and C, respectively. Eighty-three patients (12.9%) were diagnosed with AKI, the most common cause for which was dehydration (30 patients). Three patients had hepatorenal syndrome type 1 and 26 patients had prerenal-type AKI caused by volume deficiency after variceal bleeding. In addition, 22 patients (3.4%) were diagnosed with CKD, 1 patient with hepatorenal syndrome type 2, and 3 patients (0.5%) with AKI on CKD. CONCLUSIONS: Both AKI and CKD are common among hospitalized cirrhotic patients, and often occur simultaneously (16.8%). The most common type of renal dysfunction was AKI (12.9%). Diagnosis of type 2 hepatorenal syndrome remains difficult. A prospective cohort study is warranted to evaluate the clinical course in cirrhotic patients with renal dysfunction.
Acute Kidney Injury/*epidemiology/etiology/mortality ; Adult ; Aged ; Cohort Studies ; Female ; Hospital Mortality ; Humans ; Kidney Failure, Chronic/*epidemiology/etiology/mortality ; Liver Cirrhosis/complications/*diagnosis ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Severity of Illness Index ; Survival Rate

The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.
Acute Disease ; Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Cholestasis/epidemiology/etiology ; Demography ; Hepatitis A/complications/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/epidemiology/etiology ; Liver Transplantation ; Middle Aged ; Morbidity ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Young Adult

BACKGROUND/AIMS: Transcatheter arterial chemoembolization (TACE) is a major modality in the treatment of unresectable hepatocellular carcinoma. Acute renal failure (ARF) may occur after TACE because of underlying liver cirrhosis and the presence of radiocontrast agent. However, the data available regarding this complication are variable and limited. The aim of this study was to determine the incidence and associated risk factors of ARF after TACE. METHODS: From January 2001 to December 2004, a total of 632 procedures were performed in 377 patients. Of these, the cases with high creatinine levels (> or = 2 mg/dL) before TACE and with incomplete medical records were excluded, which resulted in 463 procedures in 319 patients (256 males and 63 females; age 58.7+/-9.9 years, mean+/-SD) being examined for this study. Various clinical and radiological data before and after the procedure were reviewed retrospectively. RESULTS: ARF occurred following 15 (3.2%) of the 463 procedures within 7 days of TACE. Univariate analysis revealed that serum albumin levels (P=0.025), Model for End-Stage Liver Disease score (P=0.001), the distribution of Child-Pugh class (P=0.027), and the proportions of patients with ascites (P<0.001), using diuretics (P=0.010), and with a serum creatinine level > or = 1.5 mg/dL (P=0.023) differed significantly between patients with or without ARF after TACE. In multivariate analysis, the presence of ascites (P=0.005; odds ratio, 5.297) and serum creatinine level > or = 1.5 mg/dL (P=0.007; odds ratio, 7.358) were independently associated with the development of ARF. CONCLUSIONS: The incidence of ARF after TACE was 3.2%, and the presence of ascites and an abnormal baseline serum creatinine level were the risk factors for ARF.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/complications/radiography/*therapy ; Chemoembolization, Therapeutic/*adverse effects/mortality ; Creatinine/blood ; Female ; Humans ; Incidence ; Kidney Failure, Acute/*epidemiology/etiology ; Liver Neoplasms/complications/radiography/*therapy ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Analysis