• Pietro Amoroso, Salvatore Buonocore, Gennaro Lettieri, Gaetano Pesce, Paola Pierri, Raffaele De Sena, Giuseppe Morelli, Bianca Matteis, Chiara Dell'isola, Valeria De Marino, Anna R Ciccaglione, Rodolfo Punzi, Ciro Esposito, and Enea Spada.
• Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy - pietro.amoroso@gmail.com.
• Minerva Med. 2020 Aug 1; 111 (4): 330-336.

BackgroundAcute liver failure (ALF) is a rare but often lethal syndrome. In Italy, recent data on its incidence and causes are lacking. We report here the epidemiological analysis of ALF cases observed in Campania, a Southern Italian region, over the last 25 years.MethodsMedical records of ALF cases hospitalized from 1992 to 2018 were retrospectively analyzed.ResultsTwo hundred ten ALF cases occurred during 1992-2018: 103 (49%) hepatitis B virus (HBV)-related (including 5 cases also infected with Delta virus), 39 (19%) from undetermined cause, 36 (17%) drug-induced, 11 (5%) Wilson's disease-associated, 8 (4%) hepatitis A virus (HAV)-related and 12 (6%) from other causes. Separate time-periods analysis of data showed a significant progressive decrease in ALF incidence mainly attributable to a decline of HBV and other viruses etiology. Already before 2010, HAV or Delta virus-related cases have no longer been observed. No hepatitis C or E virus-related ALF was detected through the study period. A progressive decrease in frequency of ALF due to undetermined causes or drug was also evident.ConclusionsA decrease in ALF incidence and a changing in its etiology were observed in Campania during 1992-2018. Both results were likely mainly due to 1991 introduction of HBV universal vaccination and may be considered generalizable nationwide.

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