Risk Factors of Invasive Pulmonary Fungal Infections in Patients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure

Xinchun He,Shigang Tang,Liang Chen,Caixia Yang,Yuqing Feng,Baining Zhu,Songwen Tan

doi:10.1155/2021/9260259

Abstract

To analyze the risk factors of invasive pulmonary fungal infections in patients with HBV-ACL, the clinical data and risk factors of 60 patients with HBV-ACLF complicated IPFI were analyzed retrospectively including clinical parameters, broad-spectrum antibiotics usage, neutropenia, invasive medical manipulations, serum total bilirubin, international normalized ratio (INR), and MELD scores were compared with non-IPFI. Risk factors were analyzed using mathematical tools. Candida species and Aspergillus were detected as the most prominent fungal strains (61.11% and 33.33%, respectively). The risk factors included prolong broad-spectrum antibiotic usage OR = 4.362 , P = 0.008 , neutropenia OR = 3.288 , P = 0.007 , invasive procedures OR = 3.263 , P = 0.010 , serum total bilirubin OR = 1.006 , P = 0.011 , INR OR = 2.101 , P = 0.007 , and MELD scores OR = 1.074 , P = 0.008 . Candida is the main IPFI strains in patients with HBV-ACLF. Broad-spectrum antibiotics usage, neutropenia, invasive manipulations, and the severity of ACLF might be risk factors for IPFI in patients with HBV-ACLF.

Highlights

Acute-on-chronic liver failure (ACLF) is a common medical liver disease syndrome with a high risk of short-term death and demonstrated immune dysfunction [1,2,3]
The introduction and the expanded access to antiviral treatment have significantly improved the outcome of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) [3, 5,6,7,8], infections displayed a significant public health problem, contributed to increase prolonged hospitalization and additional healthcare costs, and made a deterioration in the morbidity and mortality
The patients with Invasive pulmonary fungal infections (IPFI) had more prolonged antibiotics use [54 (90.00%) versus 51 (61.45%); P ≤ 0:001], and invasive operation [46 (76.67%) versus 39 (46.98%); P ≤ 0:001]; the number of patients with neutropenia, total bilirubin, international normalized ratio (INR), and Model for End-Stage Liver Disease (MELD) scores are larger for IPFI groups [41 (68.33%) versus 27 (32.53%); P ≤ 0:001], [389:22 ± 103:41 versus 326:15 ± 102:01; P ≤ 0:001], [3:16 ± 0:84 versus 2:67 ± 0:78; P ≤ 0:001], and [34:87 ± 8:39 versus 30:03 ± 8:24; P ≤ 0:001], respectively (Table 1)

Summary

Introduction

Acute-on-chronic liver failure (ACLF) is a common medical liver disease syndrome with a high risk of short-term death and demonstrated immune dysfunction [1,2,3]. The introduction and the expanded access to antiviral treatment have significantly improved the outcome of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) [3, 5,6,7,8], infections displayed a significant public health problem, contributed to increase prolonged hospitalization and additional healthcare costs, and made a deterioration in the morbidity and mortality. Invasive pulmonary fungal infections (IPFI) play an important role in stimulating and aggravating liver failure [9, 10]. It remained extremely challenging to be timely and accurately diagnosed, since the onset of invasive pulmonary fungal infections (IPFI) is occult, and the early clinical manifestations such as fever, tachycardia, and cough are not specific and overlap with symptoms of bacterial infections. Recent studies have revealed that (1,3)-β-D-glucan (BDG) and galactomannan (GM) in blood or respiratory samples

Methods

Results

Discussion

Conclusion