Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure

doi:10.12998/wjcc.v7.i16.2204

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 7, Issue 16

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (4354)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-3) series, Tables (1-5) series.

Item

Count

PDF

232

WORD

231

HTML

1674

Figures (1-3)

218

Tables (1-5)

183

Sum=2538

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

627

Download

1189

Sum=1816

Aug 26, 2019 (publication date) through May 3, 2024

Times Cited of This Article

Times Cited (2)

Journal Information of This Article

Publication Name

World Journal of Clinical Cases

ISSN

2307-8960

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Clin Cases. Aug 26, 2019; 7(16): 2204-2216
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2204

Table 1 Baseline characteristics of hepatitis B virus-related acute-on-chronic liver failure patients with and without infections

	Total (n = 174)	Infection (n = 114)	No infection (n = 60)	t/χ²/z	P-value
Age (yr)	47.44 ± 11.49	49.28 ± 11.32	43.95 ± 11.10	2.972	0.003
Male, n (%)	138 (79.31)	82 (71.93)	56 (93.33)	10.975	0.001
Hepatic encephalopathy	25 (14.37)	23 (20.18)	2 (3.33)	9.063	0.002
Hepatorenal syndrome	11 (6.32)	10 (8.77)	1 (1.67)	3.351	0.100
Gastrointestinal hemorrhage	11 (6.32)	10 (8.77)	1 (1.67)	3.351	0.100
ACLF-1	41 (23.56)	15 (13.16)	26 (43.33)	19.874	0.000
ACLF-2	51 (29.31)	31 (27.19)	20 (33.33)	0.715	0.398
ACLF-3	82 (47.13)	68 (59.65)	14 (23.33)	20.806	0.000
INR	2.09 (1.07)	2.215 (1.24)	1.835 (0.695)	-3.193	0.001
ALB (g/L)	32.38 ± 5.31	31.42 ± 4.63	34.197 ± 6.06	-3.110	0.002
Cr (μmol/L)	55.65 (35.425)	57.20 (41.175)	55.00 (25.525)	-1.604	0.109
Na (mmol/L)	138.20 (6.52)	137.25 (7.95)	139.1 (5.325)	-2.752	0.006
WBC (G/L)	5.375 (3.623)	6.32 (4.07)	4.64 (3.085)	-3.655	0.000
NE%	69.85 (16.55)	72.95 (13.875)	63.15 (12.95)	-4.300	0.000
ALT (U/L)	379.50 (842.25)	305.5 (608.75)	793.5 (867.5)	-4.050	0.000
AST (U/L)	260.50 (591)	224.5 (342.5)	599.0 (858.25)	-4.001	0.000
TBIL (μmol/L)	260.16 ± 128.63	277.2 ± 134.7	227.8 ± 110.13	2.599	0.010
PT (S)	23.30 (11.325)	25.20 (14.3)	21.15 (7.15)	-2.956	0.003
MELD	20.58 ± 8.52	22.33 ± 8.92	17.25 ± 6.58	4.267	0.000
MELD-Na	22.51 ± 10.44	25.09 ± 11.14	17.6 ± 6.7	5.525	0.000
iMELD	38.81 ± 10.87	41.74 ± 11.38	33.23 ± 7.05	6.076	0.000
ALBI	-1.205 ± 0.53	-1.103 ± 0.45	-1.399 ± 0.613	3.293	0.001
CTP	11.00 (2)	12.00 (2)	10.00 (2.75)	-4.896	0.000

TBIL: Total bilirubin; PT: Prothrombin time; WBC: White blood cells; NE%: Percentage of neutrophils; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin. INR: Standardized international ratio; Cr: Creatinine; Na: Sodium; CTP: Child-Turcotte-Pugh; MELD: Model for End-Stage Liver Disease; MELD-Na: MELD-sodium; iMELD: Integrated MELD; ALBI: Albumin-bilirubin; ACLF-1: Acute-on-chronic liver failure grade 1; ACLF-2: Acute-on-chronic liver failure grade 2; ACLF-3: Acute-on-chronic liver failure grade 3.

Table 2 Positivity rate among 188 cultured samples

	Samples	Positive samples	Positive rate (%)
Ascites	63	3	4.76
Sputum	44	23	52.27
Blood	39	3	7.69
Urine	19	4	21.05
Throat swab	10	5	50
Stool	10	0	0
Bone marrow	2	0	0
Other secretion	1	1	100
Total	188	39	20.74

Table 3 Distribution of bacteria and fungi and source of specimens

	Total	constituent ratio (%)	Source of specimens (n = 41)
	Total	constituent ratio (%)	Ascites	Sputum	Blood	Urine	Throat swab	Other secretion
Escherichia coli	3	7.32	2	0	0	1	0	0
Enterococcus faecium	2	4.88	1	0	0	1	0	0
Klebsiella pneumoniae	4	9.76	0	4	0	0	0	0
Acinetobacter baumannii	2	4.88	0	2	0	0	0	0
Enterobacter aerogenes	3	7.32	0	2	0	0	1	0
Staphylococcus aureus	2	4.88	0	1	1	0	0	0
Klebsiella ozaenae	1	2.44	0	1	0	0	0	0
Enterococcus faecalis	1	2.44	0	0	1	0	0	0
Streptococcus haemolyticus	1	2.44	0	0	1	0	0	0
Streptococcus agalactiae	1	2.44	0	0	0	1	0	0
Staphylococcus haemolyticus	1	2.44	0	0	0	0	0	1
yeast-like fungi	8	19.51	0	6	0	1	1	0
Candida	11	26.83	0	8	0	0	3	0
Aspergillus fumigatus	1	2.44	0	1	0	0	0	0

Table 4 Risk factors for the development of bacterial and/or fungal infections

		Total	Secondary infectionn (%)	χ²	OR (95%CI)	P-value
Gender	Female	36	32 (88.89)	9.263	5.46 (1.83, 16.31)	0.002
	Male	138	82 (59.42)
Age (yr)	≥ 45	107	80 (74.77)	10.214	2.88 (1.51, 5.49)	0.001
	< 45	67	34 (50.75)
HBVDNA (IU/mL)	< 4.575 × 10⁵	79	59 (74.68)	6.281	2.32 (1.20, 4.46)	0.012
	≥ 4.575 × 10⁵	95	55 (57.89)
Stage of liver failure	Middle and late	131	102 (77.9)	30.459	9.09 (4.15, 19.89)	0.000
	Early	43	12 (27.91)
ACLF grade	ACLF-1	41	15 (36.59)	18.117	5.05 (2.40, 10.64)	0.000
	ACLF-(2, 3)	133	99 (74.44)
ALT (U/L)	< 493.5	97	75 (78.95)	15.273	3.71 (1.92, 7.17)	0.000
	≥ 493.5	77	39 (50.65)
AST (U/L)	<538.5	120	92 (76.67)	19.847	4.78 (2.40, 9.51)	0.000
	≥ 538.5	54	22 (40.74)
TBIL (µmol/mL)	≥ 348.35	40	34 (85)	7.925	3.83 (1.50, 9.73)	0.005
	< 348.35	134	80 (59.7)
WBC (G/L)	≥ 10	24	24 (100)	7.099	15.73 (2.07, 119.45)	0.008
	< 10	150	90 (60)
NE%	> 70	86	71 (82.56)	20.283	4.95 (2.47, 9.94)	0.000
	≤ 70	88	43 (48.86)
Hospital stay (d)	≥ 30	48	40 (83.33)	9.312	1.45 (0.66, 3.17)	0.003
	< 30	126	74 (58.73)
ALB (g/L)	≤ 33.1	101	76 (75.25)	9.812	2.80 (1.47, 5.33)	0.002
	> 33.1	73	38 (52.05)
PT (s)	≥ 27.55	58	48 (82.76)	10.685	3.64 (1.68, 7.89)	0.001
	< 27.55	116	66 (56.89)

TBIL: Total bilirubin; PT: Prothrombin time; WBC: White blood cells; NE%: Percentage of neutrophils; ALT: Alanine aminotransferase; ALB: Albumin. AST: Aspartate aminotransferase; ACLF grade: Acute-on-chronic liver failure grade; ACLF-1: Acute-on-chronic liver failure grade 1; ACLF-(2, 3): Acute-on-chronic liver failure grades 2 and 3.

Table 5 Correlation of grades of acute-on-chronic liver failure and liver failure scores with bacterial and/or fungal infections

	Total, n	Infection, n(%)	No infection n (%)	Corelation coefficient	Sig	χ²	P-value
ACLF grade	174	114	60	0.365	0.000	26.697	0.000
ACLF-1	41	15 (36.59)	26 (63.41)
ACLF-2	51	31 (60.78)	20 (39.22)
ACLF-3	82	68 (82.93)	14 (17.07)
MELD	174	114	60	0.285	0.001	15.421	0.001
< 20	87	46 (52.87)	41 (47.13)
20-29	62	45 (72.58)	17 (27.42)
30-39	21	19 (90.48)	2 (9.52)
≥ 40	4	4 (100)	0
MELD-Na	174	114	60	0.294	0.001	16.475	0.001
< 25	121	69 (57.02)	52 (42.98)
25-34	31	23 (74.19)	8 (25.81)
35-44	17	17 (100)	0
≥ 45	5	5 (100)	0
iMELD	174	114	60	0.368	0.000	27.181	0.000
< 30	32	15 (46.88)	17 (53.12)
30-39	74	39 (52.7)	35 (47.3)
40-49	41	34 (82.93)	7 (17.07)
50-59	20	19 (95)	1 (5)
≥ 60	7	7 (100)	0
ALBI	174	114	60	0.215	0.015	8.454	0.015
≤ -2.60	4	1 (25)	3 (75)
-2.60~-1.39	49	26 (53.06)	23 (46.94)
> -1.39	121	87 (71.9)	34 (28.1)
CTP	174	114	60	0.257	0.000	12.301	0.000
5-9	33	13 (39.4)	20 (60.6)
≥ 10	141	101 (71.63)	40 (28.37)

CTP: Child-Turcotte-Pugh; MELD: Model for End-Stage Liver Disease; MELD-Na: MELD-sodium; iMELD: Integrated MELD; ALBI: Albumin-bilirubin; ACLF grade: Acute-on-chronic liver failure grade; ACLF-1: Acute-on-chronic liver failure grade 1; ACLF-2: Acute-on-chronic liver failure grade 2; ACLF-3: Acute-on-chronic liver failure grade 3.

Citation: Wang C, Ma DQ, Luo S, Wang CM, Ding DP, Tian YY, Ao KJ, Zhang YH, Chen Y, Meng ZJ. Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure. World J Clin Cases 2019; 7(16): 2204-2216
URL: https://www.wjgnet.com/2307-8960/full/v7/i16/2204.htm
DOI: https://dx.doi.org/10.12998/wjcc.v7.i16.2204