GPT and Fulminant hepatitis: Several studies from Japan have shown that HEV-4 patients had a significantly higher peak alanine aminotransferase (ALT) level and significantly higher proportion of prothrombin time (PT) ≤60% than HEV-3 patients, and that fulminant hepatitis events were significantly more frequent in HEV-4 patients than in HEV-3 patients, suggesting that the HEV genotype is an important risk factor associated with the disease severity [136,172,173].