Hepatitis D Virus Infection Increases the Risk of Liver Failure: A Systematic Review and Meta-analysis

Hepatitis D virus (HDV) infection causes the most severe form of chronic viral hepatitis in humans, yet whether it elevates liver failure risk remains unclear. To evaluate this association, we conducted a systematic review/meta-analysis searching PubMed, EMBASE, Web of Science, and Cochrane Library using terms "hepatitis Delta," "hepatitis B virus," "liver failure," and "fulminant hepatitis," comparing LF risk in HDV/HBV co-infected versus HBV mono-infected patients. Our analysis of 16 studies (n = 2,990) demonstrated significantly higher LF risk in co-infected patients (OR = 4.41; 95% CI: 2.37–8.18; P = 0.000), with subgroup analysis confirming persistently elevated risk irrespective of publication year, geographical region and co-infection status. We conclude HDV/HBV co-infection significantly increases LF risk compared to HBV mono-infection.