Mortality from viral hepatitis affects 1 in every 5 patients aged 80 in the SUS

Hospital mortality rises steadily with age: from 6.5% among adults aged 18 to 59, it increases to 14.2% in the 60 to 69 age group, reaches 16.1% between 70 and 79 years of age and reaches 20.9% from the age of 80 onwards. Global mortality, considering all age groups, was 7.8% in the period.

The survey gains relevance in Yellow July, the month of awareness about the disease, with the 28th of July being World Day to Fight Viral Hepatitis. These are infections that affect the liver, causing mild, moderate or severe changes.

In many cases, infections are silent, that is, they do not present symptoms. They can, however, manifest as tiredness, fever, malaise, dizziness, nausea, vomiting, abdominal pain, yellowish skin and eyes, dark urine and light stools.

The survey only considered hospitalizations in which viral hepatitis was the main diagnosis, according to codes B15 to B19 of the ICD-10 (International Classification of Diseases), which guarantees that the hospitalization had hepatitis as the central cause, not as a comorbidity.

According to Alexandre Naime Barbosa, head of the Department of Infectious Diseases at Unesp (Universidade Estadual Paulista) and member of the board of directors of the Brazilian Society of Clinical Medicine, the finding on mortality in the elderly shows that the prognosis of hepatitis does not depend solely on the virus.

"It is not just the virus alone that defines the prognosis. It is the combination between the infection, age, pre-existing clinical conditions and the moment at which the diagnosis is made", he states.

He draws attention to the fact that Brazil is aging with a portion of the population that acquired hepatitis B or C decades ago, but was not diagnosed. “If we do not expand testing and longitudinal care, we will probably see more complex hospitalizations in this population,” he says.

Infections caused by hepatitis B, C and D viruses often become chronic. The disease can progress for decades without proper diagnosis, and can be the cause of advanced fibrosis or cirrhosis, which can lead to the development of liver cancer and the need for organ transplantation.

Another finding is that mortality among patients hospitalized for chronic hepatitis (10.1%) is higher than in acute cases (7.1%).

For Barbosa, this has a clinical explanation. "Acute hepatitis is a recent episode of liver inflammation and, in many patients, can progress to complete recovery. Chronic hepatitis means that the virus remained in the body for a long time, causing continuous aggression to the liver tissue", he states.

The infectious disease specialist reinforces that the absence of symptoms does not mean the absence of risk. "Many people feel well, but the injury process continues to happen. This is one of the great challenges of viral hepatitis."

REGIONAL INEQUALITY

Analysis of DataSUS data points to the North as the region with the highest incidence of hospitalizations for viral hepatitis, with 39.7 hospitalizations per 100,000 inhabitants - a reflection, according to Barbosa, of the greater circulation of hepatitis B and, in some areas, hepatitis D in the Amazon region. Acre, Rondônia, Amazonas and Pará are among the states with the most hospitalizations.

The Northeast recorded the highest hospital mortality among the regions (9.1%), and the longest average length of stay (8.1 days). The South, on the other hand, recorded the lowest mortality (6.5%) and the shortest hospital stay (6 days).

"I would avoid attributing these differences solely to the biology of the virus. They also reflect inequalities in access, irregular distribution of specialists, diagnostic capacity, network organization and availability of monitoring", says the infectious disease specialist.

The SUS offers vaccines against hepatitis A and B, as well as diagnosis and treatment for hepatitis B and C. The Ministry of Health has set the goal of eliminating viral hepatitis as a public health problem by 2030.

"We already have very effective tools. The challenge is not only in the existence of these technologies, but in getting them to the right people at the right time", says Barbosa, citing the elderly, people who have received previous transfusions, drug users and the population deprived of liberty as priority groups for expanding testing.

"Hepatitis may be silent, but its consequences are not. What we need to avoid is that the hospital is the first place where this disease finally appears", he concludes.

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