Chinese Hepatolgy ›› 2022, Vol. 27 ›› Issue (2): 148-151.

• Liver Failure • Previous Articles     Next Articles

Risk factors of infection in patients with HBV-related ACLF and its influence on prognosis

HUANG Chong1, ZHONG Qi-sheng2, YU Kang-kang1, LIU Chuan-miao3   

  1. 1. Department of Infectious Diseases, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China;
    2. Department of Infectious Diseases, Xingguo People's Hospital, Jiangxi 342400, China;
    3. Department of Infectious Diseases, the First Affiliated Hospital of Bengbu Medical College, Anhui 233000, China
  • Received:2021-07-03 Online:2022-02-28 Published:2022-04-19
  • Contact: LIU Chuan-miao,Email: liuchuanmiao119@sina.com

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Abstract: Objective To investigate the risk factors of infection in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) and its prognosis. Methods Clinical data of patients with HBV-ACLF admitted from 2007 to 2016 were retrospectively analyzed. Risk factors and incidence rates of different kinds of infection were analyzed, as well as the influence of infection on 60-day survival. Results A total of 293 patients with HBV-ACLF in accordance with the Asian Pacific association for the study of the liver (APASL) criteria (except total bilirubin) were included, of which 92 patients complied with ACLF grade 2-3 of European association for the study of the liver (EASL) CLIF-C criteria. Compared with ACLF 0-1 (34%) patients, the incidence rate of overall infection within 60 days was higher in CLIF-C ACLF 2-3 (54%) patients (P=0.001). A total of 162 patients were treated with corticosteroid and the incidence rates of ‘pulmonary infection', ‘invasive fungal infection/other opportunistic infection', and ‘overall infection' were higher than the patients who were not treated with corticosteroid (19% vs 7% P=0.003, 7% vs 0% P=0.001 and 54% vs 24% P<0.001). Cox multivariate analysis revealed that corticosteroid therapy was an independent risk factor of the infection mentioned above. Sixty-day survival rate of ACLF 0-1 patients combined with infection was lower than that of patients without infection (58% vs 77%, P=0.005), but with no significant difference of 60-day survival rate between ACLF 2-3 patients with infection and those without infection. In univariate analysis, age ≥ 45, ACLF grade 2-3 at baseline, pulmonary infection and overall infection were risk factors of death within 60 days. In multivariate analysis, only age ≥ 45 (HR 1.585, 95%CI 1.183-2.591) and ACLF grade 2-3 at baseline (HR 2.542, 95%CI 1.427-3.673) were independent risk factors of death within 60 days. Conclusion There is a high incidence rate of infection in patients with HBV-ACLF, and corticosteroid therapy was the major risk factor. The survival rates of patients belonging to ACLF grade 0-1 decline when infection occurs.

Key words: Acute-on-chronic liver failure, Infection, Hepatitis B virus, Prognosis