Zhai Xing-Ran, Tong Jing-Jing, Wang Hong-Min, Xu Xiang, Mu Xiu-Ying, Chen Jing, Liu Zi-Feng, Wang Yu, Su Hai-Bin, Hu Jin-Hua
Peking University 302 Clinical Medical School, Beijing, China.
Liver Failure Treatment and Research Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
BMC Gastroenterol. 2020 Sep 29;20(1):320. doi: 10.1186/s12876-020-01473-y.
Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. However, the characteristics of infection and its influence on prognosis in hepatitis B virus related ACLF (HBV-ACLF) as defined by the European Association for the Study of the Liver (EASL) have not been clarified. We aimed to investigate the characteristics of infection and its influence on mortality in patients with HBV-ACLF defined by EASL in China.
We performed a retrospective cohort study in patients with HBV-ACLF defined by EASL in a single center from January 2015 to December 2017. These patients were divided into two groups with and without infection. The incidence, sites of infection, isolated strains, and risk factors associated with mortality were evaluated.
A total of 289 patients were included, among them 185 (64.0%) were diagnosed with an infection. The most common type of infection was pneumonia (55.7%), followed by spontaneous bacterial peritonitis (47.6%) and others. The gram-negative bacteria were the most frequent (58.3%). Patients with one, two, and three or more infection sites had a gradually increasing incidence of sepsis (P < 0.01), septic shock (P < 0.001), and ACLF-3 (P < 0.05). Also, patients with infection isolated one, two, and three or more strains showed a growing incidence of sepsis (P < 0.01) and septic shock (P < 0.001). Patients with infection showed a significantly higher 28-day mortality than those without (P < 0.01), especially in patients with ACLF-3. Infection was identified as an independent risk factor for 28-day mortality in all HBV-ACLF patients. Pneumonia and sepsis were identified as independent predictors of 28-day mortality for patients with infection.
Infection is associated with severe clinical course and high mortality in HBV-ACLF defined by EASL. The increased number of infection sites or isolated strains was associated with the occurrence of sepsis and septic shock. Pneumonia and sepsis were independent predictors for mortality in HBV-ACLF patients with infection.
感染在慢加急性肝衰竭（ACLF）中很常见，这可能会使临床病情和预后恶化。然而，欧洲肝脏研究协会（EASL）定义的乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）中的感染特征及其对预后的影响尚未阐明。我们旨在研究中国EASL定义的HBV-ACLF患者的感染特征及其对死亡率的影响。
我们对2015年1月至2017年12月在单中心确诊为EASL定义的HBV-ACLF患者进行了一项回顾性队列研究。这些患者被分为感染组和非感染组。评估感染的发生率、感染部位、分离菌株以及与死亡率相关的危险因素。
共纳入289例患者，其中185例（64.0%）被诊断为感染。最常见的感染类型是肺炎（55.7%），其次是自发性细菌性腹膜炎（47.6%）及其他。革兰氏阴性菌最为常见（58.3%）。有1个、2个以及3个或更多感染部位的患者发生脓毒症（P < 0.01）、感染性休克（P < 0.001）和ACLF-3（P < 0.05）的发生率逐渐增加。此外，分离出1种、2种以及3种或更多菌株的感染患者发生脓毒症（P < 0.01）和感染性休克（P < 0.001）的发生率也在增加。感染患者的28天死亡率显著高于未感染患者（P < 0.01），尤其是ACLF-3患者。感染被确定为所有HBV-ACLF患者28天死亡率的独立危险因素。肺炎和脓毒症被确定为感染患者28天死亡率的独立预测因素。
在EASL定义的HBV-ACLF中，感染与严重的临床病程和高死亡率相关。感染部位或分离菌株数量的增加与脓毒症和感染性休克的发生有关。肺炎和脓毒症是HBV-ACLF感染患者死亡率的独立预测因素。
