Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2204-2216
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2204
Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure
Chen Wang, De-Qiang Ma, Sen Luo, Chuan-Min Wang, De-Ping Ding, You-You Tian, Kang-Jian Ao, Yin-Hua Zhang, Yue Chen, Zhong-Ji Meng
Chen Wang, De-Qiang Ma, Sen Luo, Chuan-Min Wang, De-Ping Ding, You-You Tian, Kang-Jian Ao, Yin-Hua Zhang, Yue Chen, Zhong-Ji Meng, Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Zhong-Ji Meng, Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Author contributions: All authors helped to perform the research; Wang C, Ma DQ, Luo S, Wang CM, Ding DP, Tian YY, Ao KJ, and Zhang YH collected and analyzed the data; Meng ZJ and Chen Y designed and coordinated the research; Wang C and Meng ZJ wrote the paper; all authors read and approved the manuscript.
Supported by the Foundation for Innovative Research Groups of Natural Science Foundation of Hubei Province of China, No. 2018CFA031; Precision Medical Project Granted by National Key Research and Development Program, No. 2017YFC0908104; Research and Development Project of Science and Technology Plan of Shiyan, No. 18K78; and Key Program for Precision Medicine of Taihe Hospital, No. 2016JZ05.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Shiyan Taihe Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhong-Ji Meng, MD, Chief Doctor, Full Professor, Research Scientist, Institute of Biomedical Research, Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, No. 32, South Renmin Road, Shiyan 442000, Hubei Province, China. zhongji.meng@163.com
Telephone: +86-719-8876628 Fax: +86-719-8876627
Received: April 22, 2019
Peer-review started: April 22, 2019
First decision: May 9, 2019
Revised: June 20, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 26, 2019
Processing time: 128 Days and 13 Hours
Abstract
BACKGROUND

In China, hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is the most common liver failure characterized by serious clinical syndromes of liver decompensation with a very high mortality. Bacterial and/or fungal infections are the most common complications that are associated with high short-term mortality. Bacterial translocation from the intestine, impaired hepatic clearance, and immune paralysis of circulating immune cells are thought to contribute to infectious complications in liver failure. The control of bacterial and fungal infections is the key to improving HBV-ACLF outcomes. Active prevention, early diagnosis, and timely treatment of bacterial and fungal infections are essential for treating HBV-ACLF.

AIM

To investigate the frequency and role of bacterial and fungal infections in patients with HBV-ACLF.

METHODS

Patients with HBV-ACLF hospitalized at Taihe Hospital, Hubei University of Medicine from January 2014 to December 2017 were retrospectively enrolled. Patient-related information was retrieved from the hospital case database, including general information, blood biochemistry, complications, etc. According to the occurrence of secondary infection or not, the patients were divided into an infection group and a non-infection group. The sites, types, and incidences of bacterial and fungal infections and the influence of infections on the prognosis of HBV-ACLF were statistically analyzed. The risk factors for infections were assessed by unconditional logistic regression.

RESULTS

There were 174 cases of HBV-ACLF that met the enrollment criteria, of which 114 (65.52%) were diagnosed with infectious complications. Infections occurred in the abdominal cavity (87 cases), respiratory tract (51 cases), urinary tract (18 cases), and biliary tract (10 cases). Patients with infectious complications had a significantly higher 28-d mortality (70.18%, 80/114) than those without (40.00%, 24/60) (70.18% vs 40.00%, P < 0.05). And patients with infectious complications had a much higher incidence of non-infectious complications (54.39%, 62/114) (54.39% vs 15.00%, P < 0.05), leading to an extremely high 28-d mortality of 88.71% (55/62) (P < 0.05). The grade of liver failure, period of hospital stay ≥ 30 d, age ≥ 45 years, and percentage of neutrophils > 70% were identified as risk factors for infectious complications.

CONCLUSION

The high incidence of infectious complications in patients with HBV-ACLF is associated with severity and deterioration of the disease and may contribute to the extremely high mortality of these patients.

Keywords: Hepatitis B; Acute-on-chronic liver failure; Bacterial infection; Fungal infection; Prognosis

Core tip: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is the most common type of liver failure with a high mortality and complications. Bacterial and/or fungal infections are the most common complications of liver failure. The aim of this study was to investigate the frequency and role of bacterial and fungal infections in patients with HBV-ACLF. A total of 174 patients with HBV-ACLF were retrospectively analyzed. Patients with infectious complications had a significantly higher mortality (70.18%) than those without (40.00%, 24/60). In conclusion, infections can significantly increase the mortality rate of liver failure.