Early diagnosis of bacterial and fungal infection in chronic cholestatic hepatitis B

doi:10.3748/wjg.v10.i15.2228

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Viral Hepatitis

World J Gastroenterol. Aug 1, 2004; 10(15): 2228-2231
Published online Aug 1, 2004. doi: 10.3748/wjg.v10.i15.2228

Early diagnosis of bacterial and fungal infection in chronic cholestatic hepatitis B

Xiong-Zhi Wu, Dan Chen, Lian-San Zhao, Xiao-Hui Yu, Mei Wei, Yan Zhao, Qing Fang, Qian Xu

Xiong-Zhi Wu, Lian-San Zhao, Xiao-Hui Yu, Yan Zhao, Qing Fang, Qian Xu, Infectious Disease Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China

Dan Chen, Mei Wei, Luzhou Medical College, Luzhou 646000, Sichuan Province, China

Author contributions: All authors contributed equally to the work.

Correspondence to: Xiong-Zhi Wu, Infectious Disease Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. ilwxz@163.com

Telephone: +86-28-85422650 Fax: +86-28-85423783

Received: January 2, 2004
Revised: January 3, 2004
Accepted: January 12, 2004
Published online: August 1, 2004

Abstract

AIM: To investigate the early diagnostic methods of bacterial and fungal infection in patients with chronic cholestatic hepatitis B.

METHODS: One hundred and one adult in -patients with chronic hepatitis B were studied and divided into 3 groups: direct bilirubin (DBil)/total bilirubin (TBil) ≥ 0.5, without bacterial and fungal infection (group A, n = 38); DBil/TBil < 0.5, without bacterial and fungal infection (group B, n = 23); DBil/TBil ≥ 0.5, with bacterial or fungal infection (group C, n = 40). The serum biochemical index and pulse rate were analyzed.

RESULTS: Level of TBil, DBil, alkaline phosphatase (ALP) and DBil/ALP in group A increased compared with that in group B. The level of ALP in group C decreased compared with that in group A, whereas the level of TBil, DBil and DBil/ALP increased (ALP: 156 ± 43, 199 ± 68, respectively, P < 0.05; TBil: 370 ± 227, 220 ± 206, respectively, P < 0.01; DBil: 214 ± 143, 146 ± 136, respectively, P < 0.01; DBil/ALP: 1.65 ± 1.05, 0.78 ± 0.70, respectively, P < 0.001). The level of DBil and infection affected DBil/ALP. Independent of the effect of DBil, infection caused DBil/ALP to rise (P < 0.05). The pulse rate in group A decreased compared with that in group B (63.7 ± 6.4, 77.7 ± 11.4, respectively, P < 0.001), and the pulse rate in group C increased compared with that in group A (81.2 ± 12.2, 63.7 ± 6.4, respectively, P < 0.001). The equation (infection = 0.218 pusle rate 1.064 DBil/ALP -16.361), with total accuracy of 85.5%, was obtained from stepwise logistic regression. Pulse rate (≥ 80/min) and DBil/ALP (≥ 1.0) were used to screen infection. The sensitivity was 62.5% and 64.7% respectively, and the specificity was 100% and 82.8% respectively.

CONCLUSION: Bacterial and fungal infection deteriorate jaundice and increase pulse rate, decrease serum ALP and increase DBil/ALP. Pulse rate, DBil/ALP and the equation (infection = 0.218 pusle rate + 1.064 DBil/ALP-16.361) are helpful to early diagnosis of bacterial and fungal infection in patients with chronic cholestatic hepatitis B.

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