P-1834. Clinical profile and outcomes of hepatitis A virus–associated with severe acute liver injury in adults: A case study of Delhi, India

Abstract Background Hepatitis A Virus (HAV) is undergoing an epidemiological transition, with an increasing prevalence among adults. Although uncomplicated hepatitis remains the most common presentation, evidence indicates a rising contribution of HAV to Acute Liver Failure (ALF). Between these two extremes lies severe Acute Liver Injury (s-ALI), which carries a significant risk of progressing to ALF. This study aimed to assess the clinical profile of patients with HAV-related s-ALI and identify potential predictors for its progression to ALF. Methods This study carried out single-centre retrospective analysis of adult patients admitted with HAV-related severe Acute Liver Injury (s-ALI) at the National Institute of Tuberculosis and Respiratory Diseases, New Delhi, from May 2023 to August 2024. Clinical, demographic and laboratory parameters were compared between patients with s-ALI alone and those who progressed to Acute Liver Failure (ALF). Multivariate Logistic regression model was used to identify the predictors of progression from s-ALI to ALF. Results Of 32 patients meeting s-ALI criteria, 69.2% had s-ALI alone and 30.8% progressed to ALF. Compared to HAV-ALF, s-ALI patients had lower leukocyte counts, acute kidney injury rates, MELD scores, arterial lactate, ammonia, procalcitonin, and ferritin levels. Three patients (9.1%) with s-ALI progressed to ALF, with one (4%) fatality. Baseline ammonia and leukocyte count showed trends for predicting ALF progression, neither was significant after adjustment. Ammonia levels (unadjusted odds ratio [OR] 1.1 [0.03-1.6]) and leukocyte count (OR 1.3 [0.9–1.9]) tended to be associated with ALF progression, although none was significant after multi-variable adjustment. Ammonia levels had an area under the receiver operating curve of 0.9 (0.6–1.8) (p = 0.005). Comorbidities did not affect overall outcomes. Conclusion The findings highlighted that HAV commonly found as s-ALI in young adults, with nearly 10% of cases progressing to ALF. Baseline ammonia levels may serve as a significant predictor of progression, even in s-ALI. Disclosures All Authors: No reported disclosures