Wang Chen, Ma De-Qiang, Luo Sen, Wang Chuan-Min, Ding De-Ping, Tian You-You, Ao Kang-Jian, Zhang Yin-Hua, Chen Yue, Meng Zhong-Ji
Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China.
World J Clin Cases. 2019 Aug 26;7(16):2204-2216. doi: 10.12998/wjcc.v7.i16.2204.
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, . 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% 40.00%, < 0.05). And patients with infectious complications had a much higher incidence of non-infectious complications (54.39%, 62/114) (54.39% 15.00%, 0.05), leading to an extremely high 28-d mortality of 88.71% (55/62) ( 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.
在中国，乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）是最常见的肝衰竭类型，其特征为严重的肝脏失代偿临床综合征，死亡率极高。细菌和/或真菌感染是最常见的并发症，与短期高死亡率相关。肠道细菌易位、肝脏清除功能受损以及循环免疫细胞的免疫麻痹被认为是导致肝衰竭感染并发症的原因。控制细菌和真菌感染是改善HBV-ACLF预后的关键。积极预防、早期诊断和及时治疗细菌和真菌感染对于治疗HBV-ACLF至关重要。
探讨细菌和真菌感染在HBV-ACLF患者中的发生率及作用。
回顾性纳入2014年1月至2017年12月在湖北医药学院附属太和医院住院的HBV-ACLF患者。从医院病例数据库中检索患者相关信息，包括一般信息、血液生化、并发症等。根据是否发生继发感染，将患者分为感染组和非感染组。对细菌和真菌感染的部位、类型、发生率以及感染对HBV-ACLF预后的影响进行统计学分析。通过无条件逻辑回归评估感染的危险因素。
符合纳入标准的HBV-ACLF患者共174例，其中114例（65.52%）诊断为感染并发症。感染发生于腹腔（87例）、呼吸道（51例）、泌尿道（18例）和胆道（10例）。有感染并发症的患者28天死亡率（70.18%，80/114）显著高于无感染并发症的患者（40.00%，24/60）（70.18%对40.00%，P<0.05）。并且有感染并发症的患者非感染并发症发生率更高（54.39%，62/114）（54.39%对15.00%，P<0.05），导致28天死亡率极高，达88.71%（55/62）（P<0.05）。肝衰竭分级、住院时间≥30天、年龄≥45岁以及中性粒细胞百分比>70%被确定为感染并发症的危险因素。
HBV-ACLF患者感染并发症的高发生率与疾病的严重程度和恶化相关，可能是这些患者极高死亡率的原因之一。
