Diagnostic pathways and etiological analysis of unexplained hepatitis with hyperbilirubinemia / 解放军医学杂志

ABSTRACT

Objective To sum up the diagnosis experience of unexplained hepatitis with hyperbilirubinemia (UHH) for establishing its diagnostic pathways and etiological factors. Methods By referring to the research progress at home and abroad, various examination items were made in order to form the clinical diagnosis pathway of UHH, on the basis of retrospective analysis and follow-up investigation of UHH patients. Using this pathway we carried out prospective diagnosis analysis for 223 patients admitted to Fifth Medical Center of Chinese PLA General Hospital from June 2014 to June 2017, in the order of preliminary, in-depth, and ultimate screening. Results A total of 181 cases were identified through the pathway screening (181/223, 81.17%). Two cases were etiologically diagnosed by primary screening (2/223, 0.90%), 18(18/223, 8.07%) by in-depth screening, and 161(161/223, 72.20%) by ultimate screening. There were still 42 cases (42/223, 18.83%) failing to make a definite diagnosis, among which 14 cases (14/223, 6.28%) failed to make a definite diagnosis after completing the diagnostic pathway, and 28(28/223, 12.55%) failed to complete the diagnostic pathway due to the critical condition and failure of liver puncture or rejection of genetic test. Among the 195 patients who completed diagnostic pathway, 181 cases were identified, and the actual etiology diagnosis rate was 92.82%. Among the 223 cases, 143(64.13%) were caused by drug-induced liver damage, 11(4.93%) by hereditary metabolic liver disease, 8(3.58%) by autoimmune liver disease, 5(2.24%) by infectious diseases, 14(6.28%) by other systemic diseases, and 42(18.83%) by undetermined causes. Conclusion Drug-induced liver damage, and genetic metabolic liver disease are common causes of UHH. The three-step screening pathway is effective for the diagnosis of UHH, and also simple and easy to practice, thus being worthy of promotion on a trial basis.