Serum tumor necrosis factor-alpha level in hepatitis E virus-related acute viral hepatitis and fulminant hepatic failure in pregnant women

Aim The host response in hepatitis E virus (HEV)-related liver disease of pregnant women is unclear. This study was carried out to evaluate the serum concentration of tumor necrosis factor (TNF)- in HEV-related acute viral hepatitis (AVH) and fulminant hepatic failure (FHF) in pregnant women in relation to pregnancy outcome. Methods The study included 262 pregnant and 158 non-pregnant women with jaundice. There were 160 healthy asymptomatic pregnant women and 124 healthy asymptomatic non-pregnant women as controls. The jaundiced patients were classified as AVH or FHF. Serum TNF- level was assayed by commercially available enzyme-linked immunoassay kits. Results A significantly higher level of TNF- was observed in HEV-infected pregnant women than non-HEV pregnant women (P<0.001). TNF- level was significantly higher in AVH and FHF of HEV-infected pregnant women compared with AVH and FHF of HEV infected non-pregnant women (P=0.036 and P=0.010, respectively). The HEV-infected pregnant FHF expired group had significantly higher levels of TNF- than the non-pregnant FHF expired group (P=0.025). TNF- levels were significantly higher in AVH of HEV-infected pregnant women than healthy pregnant controls (P<0.001). Higher TNF- levels were observed in HEV-infected women having preterm delivery and low birthweight newborns compared with non-HEV and healthy pregnant women. Conclusion Higher serum concentration of TNF- observed in HEV infected AVH and FHF pregnant cases shows that pregnancy with HEV infection increases TNF- secretion. TNF- may be an important factor in the outcomes of pregnancy due to HEV infection.