PREVALENCE OF HEPATITIS B AND HEPATITIS C INFECTIONS AMONG CRITICALLY ILL PATIENTS ADMITTED TO A TERTIARY CARE HOSPITAL: A COMPARATIVE EVALUATION OF ELISA, CONVENTIONAL PCR, AND TRUENAT MOLECULAR ASSAYS

Abstract

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain major causes of chronic liver disease and liver-related mortality worldwide. Critically ill patients are particularly vulnerable because delayed diagnosis may adversely affect clinical outcomes and infection control practices. Molecular assays may detect additional infections that are missed by conventional serological methods. Objectives: To determine the prevalence of HBV and HCV infections among critically ill patients admitted to a tertiary care hospital and to compare the diagnostic performance of ELISA, conventional PCR, and Truenat molecular assays. Materials and Methods: This hospital-based cross-sectional study was conducted among critically ill patients admitted to a tertiary care hospital. A total of 1,317 patients were evaluated for HBV infection and 978 patients for HCV infection. Serological screening was performed using commercially available ELISA kits. For HBV, 593 samples underwent conventional DNA PCR and 724 samples underwent Truenat testing. For HCV, 552 samples underwent conventional RNA PCR and 426 samples underwent Truenat testing. Discordant results between serological and molecular methods were retested using freshly collected blood samples. Results: Among HBV samples, 443 of 593 (74.7%) tested by conventional PCR and 492 of 724 (68.0%) tested by Truenat were positive. Among HCV samples, 252 of 552 (45.7%) tested by conventional PCR and 203 of 426 (47.7%) tested by Truenat were positive. Molecular assays identified six additional HBV infections and ten additional HCV infections that were not detected by ELISA, whereas ELISA identified three additional HCV cases. Fever (75%) and right upper abdominal pain (60%) were the predominant presenting symptoms. Hepatomegaly was observed in 34% of cases and hepatic encephalopathy developed in approximately 28% of HBV-positive patients. Conclusion: A substantial burden of HBV and HCV infections was observed among critically ill patients. Molecular assays demonstrated an incremental diagnostic yield over serological methods and identified additional infections that would otherwise have remained undiagnosed. Truenat showed performance comparable to conventional PCR and may serve as a reliable, rapid, and decentralized molecular platform for hepatitis diagnosis in resource-constrained settings.