Abstract
BackgroundInfection 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.MethodsWe 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.ResultsA 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.ConclusionsInfection 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.
Highlights
Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis
The objective of this study is to demonstrate the detailed features of infection in patients with hepatitis B virus (HBV)-ACLF defined by EASL and explore its influence on the clinical condition and 28-day mortality
Baseline characteristics of patients A total of 289 patients with HBV-ACLF were included in this study after excluding 56 patients according to the inclusion and exclusion criteria (Fig. 1), among them 236 (81.7%) were males and 53 (18.3%) were females
Summary
Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. 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. European Association for the Study of the Liver (EASL) defined ACLF as a severe clinical syndrome characterized by acute insult, organ failures (OFs), and high short-term mortality in patients with liver cirrhosi s[1]. The influence of infection on the prognosis of patients with HBV-ACLF as defined by EASL is still poorly understood
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