Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2204
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
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.
To investigate the frequency and role of bacterial and fungal infections in patients with HBV-ACLF.
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.
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.
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.
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.