Wu Yin-Ping, Li Feng-Cai, Ma Hang-Yu, Yang Xue-Yan, Zuo Jing, Tian Yu-Xin, Lv Li, Wang Kai, Fan Yu-Chen
Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China.
Clinical Follow-up Center, Qilu Hospital of Shandong University, Jinan, China.
Front Microbiol. 2024 Mar 27;15:1391814. doi: 10.3389/fmicb.2024.1391814. eCollection 2024.
The global burden of invasive fungal infections (IFIs) is emerging in immunologic deficiency status from various disease. Patients with acute-on-chronic hepatitis B liver failure (ACHBLF) are prone to IFI and their conditions are commonly exacerbated by IFI. However, little is known about the characteristics and risk factors for IFI in hospitalized ACHBLF patients.
A total of 243 hospitalized ACHBLF patients were retrospectively enrolled from January 2010 to July 2023. We performed restricted cubic spline analysis to determine the non-linear associations between independent variables and IFI. The risk factors for IFI were identified using logistic regression and the extreme gradient boosting (XGBoost) algorithm. The effect values of the risk factors were determined by the SHapley Additive exPlanations (SHAP) method.
There were 24 ACHBLF patients (9.84%) who developed IFI on average 17.5 (13.50, 23.00) days after admission. The serum creatinine level showed a non-linear association with the possibility of IFI. Multiple logistic regression revealed that length of hospitalization (OR = 1.05, 95% CI: 1.02-1.08, = 0.002) and neutrophilic granulocyte percentage (OR = 1.04, 95% CI: 1.00-1.09, = 0.042) were independent risk factors for IFI. The XGBoost algorithm showed that the use of antibiotics (SHAP value = 0.446), length of hospitalization (SHAP value = 0.406) and log (qHBV DNA) (SHAP value = 0.206) were the top three independent risk factors for IFI. Furthermore, interaction analysis revealed no multiplicative effects between the use of antibiotics and the use of glucocorticoids ( = 0.990).
IFI is a rare complication that leads to high mortality in hospitalized ACHBLF patients, and a high neutrophilic granulocyte percentage and length of hospitalization are independent risk factors for the occurrence of IFI.
侵袭性真菌感染（IFI）的全球负担在各种疾病导致的免疫缺陷状态中日益凸显。慢性乙型肝炎急性肝衰竭（ACHBLF）患者易发生IFI，且IFI常使他们的病情加重。然而，关于住院ACHBLF患者IFI的特征和危险因素知之甚少。
回顾性纳入2010年1月至2023年7月期间住院的243例ACHBLF患者。我们进行了受限立方样条分析，以确定自变量与IFI之间的非线性关联。使用逻辑回归和极端梯度提升（XGBoost）算法确定IFI的危险因素。通过夏普利值法（SHAP）确定危险因素的效应值。
24例（9.84%）ACHBLF患者发生IFI，平均在入院后17.5（13.50，23.00）天。血清肌酐水平与IFI发生可能性呈非线性关联。多因素逻辑回归显示，住院时间（OR = 1.05，95%CI：1.02 - 1.08，P = 0.002）和中性粒细胞百分比（OR = 1.04，95%CI：1.00 - 1.09，P = 0.042）是IFI的独立危险因素。XGBoost算法显示，使用抗生素（SHAP值 = 0.446）、住院时间（SHAP值 = 0.406）和log（qHBV DNA）（SHAP值 = 0.206）是IFI的前三大独立危险因素。此外，交互分析显示使用抗生素和使用糖皮质激素之间无相乘效应（P = 0.990）。
IFI是住院ACHBLF患者中导致高死亡率的罕见并发症，中性粒细胞百分比高和住院时间长是IFI发生的独立危险因素。
