Key result
The interval from the peak-ALT day to the initial HAV-test day was significantly associated with negative initial test results (OR 0.376), with all tests becoming positive at least 2 days post-peak.
Why the study?
What is the optimal time to repeat the IgM anti-HAV test in patients with clinically suspected acute hepatitis A and a negative initial test?
Observational (n=261)
No
What is the optimal time to repeat the IgM anti-HAV test in patients with clinically suspected acute hepatitis A and a negative initial test?
Odds Ratio: 0.376 (95% CI 0.189–0.747)
p-value: p=0.005
In patients with clinically suspected acute hepatitis A and a negative initial IgM anti-HAV test, repeating the test at least 2 days after the peak ALT level ensures 100% diagnostic positivity.
May support repeating IgM anti-HAV ≥2 days after peak ALT in suspected acute hepatitis A; leaves open prospective confirmation.
BACKGROUND/AIMS: The nonspecific clinical presentation of acute hepatitis A (AHA) mandates the detection of anti-hepatitis A virus IgM antibodies (IgM anti-HAV) in the serum for obtaining a definitive diagnosis. However, IgM anti-HAV might not be present during the early phase of the disease. The aim of this study was to determine the optimal time for repeating the IgM anti-HAV test (HAV test) in AHA patients with a negative initial test. METHODS: In total, 261 patients hospitalized with AHA were enrolled for this retrospective study. AHA was diagnosed when the test for IgM anti-HAV was positive and the serum alanine aminotransferase (ALT) level was ≥400 IU/L. Repeat HAV test was conducted after 1-2 weeks if the initial HAV test was negative but AHA was still clinically suspected. RESULTS: The results of the initial HAV test were negative in 28 (10.7%) patients. The intervals from symptom onset to the initial-HAV-test day and from the peak-ALT day to the initial-HAV-test day were significantly shorter in the negative-initial-HAV-test group, but on multivariate analysis only the latter was significantly associated with negative results for the initial HAV test (β=-0.978; odds ratio [95% confidence interval]=0.376 [0.189-0.747]; P=0.005). The HAV test was positive in all patients when it was performed at least 2 days after the peak-ALT day. CONCLUSIONS: The results of HAV tests were significantly associated with the interval from the peak-ALT day to the HAV-test day. The optimal time for repeating the HAV test in clinically suspicious AHA patients with a negative initial HAV test appears to be at least 2 days after the peak-ALT day.
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Hyun et al. (2012) conducted an observational in Acute hepatitis A (n=261). Interval from peak-ALT day to the initial HAV-test day was evaluated on Negative result for the initial HAV test (OR 0.376, 95% CI 0.189-0.747, p=0.005). The interval from the peak-ALT day to the initial HAV-test day was significantly associated with negative initial test results (OR 0.376), with all tests becoming positive at least 2 days post-peak.
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