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
ARTICLE HIGHLIGHTS
Research background

Bacterial and/or fungal infections are a trigger as well as a complication of liver failure, since patients with middle- or late-stage liver failure are susceptible to bacterial and fungal infections, and infection-induced sepsis is a common cause of acute-on-chronic liver failure (ACLF), while the risk factors which predispose to infections are not clear.

Research motivation

Infections are important causes of mortality in liver failure. However, the type of infection, the site of infections, predictors of infection, and their impact on outcomes in patients with hepatitis B virus-related ACLF (HBV-ACLF) are not fully elucidated. Establishing a model for predicting secondary infections in liver failure may be vital for clinical management of HBV-ACLF.

Research objectives

To investigate the influence of secondary infections on the progression of the disease and the related factors of secondary infections in patients with HBV-ACLF, and to elucidate the relationship between the infections in HBV-ACLF and the prognosis of the disease.

Research methods

Patients with HBV-ACLF at Taihe Hospital of Hubei University of Medicine from January 2014 to December 2017 were retrospectively enrolled. General information and clinical data were collected from the patient database of Taihe Hospital. The infection sites, complications, infection types, and infection rate and the influence of infections on the prognosis of HBV-ACLF were analyzed. SPSS23.0 software was used for statistical analyses. Unconditional logistic regression was used to analyze infection-related factors. The area under the receiver operating characteristic curve was used to assess the predictive power of the factors for the incidence of infections.

Research results

HBV-ACLF was susceptible to secondary infections, which were characterized by multiple sites and multiple strains. The pathogens of bacterial infection were mostly from Enterobacter, and the detection rate of pathogens was low. Patients with infectious complications had a significantly higher 28-d mortality (70.18%) than those without (40.00%, 24/60), and patients with infectious complications had a much higher incidence of non-infectious complications (54.39%, 62/114), leading to an extremely high mortality of 88.71% (55/62). 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 infection complications.

Research conclusions

The high incidence of infection complications in patients with HBV-ACLF is associated with the severity and deterioration of the disease and may contribute to the extremely high mortality of these patients. Prevention of the occurrence of infections and early diagnosis and timely treatment of infections are indispensable for the treatment of HBV-ACLF.

Research perspectives

As a retrospective study, there are limitations like relatively small number of cases and imperfect follow-up data. Especially, the long-term survival rate and related biochemical indicators are not well tracked. In the future, prospective, multi-center, large-sample cohort studies are needed.