Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure

doi:10.12998/wjcc.v7.i16.2204

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World Journal of Clinical Cases

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World J Clin Cases. Aug 26, 2019; 7(16): 2204-2216
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2204

Table 1 Baseline characteristics of hepatitis B virus-related acute-on-chronic liver failure patients with and without infections

	Total (n = 174)	Infection (n = 114)	No infection (n = 60)	t/χ²/z	P-value
Age (yr)	47.44 ± 11.49	49.28 ± 11.32	43.95 ± 11.10	2.972	0.003
Male, n (%)	138 (79.31)	82 (71.93)	56 (93.33)	10.975	0.001
Hepatic encephalopathy	25 (14.37)	23 (20.18)	2 (3.33)	9.063	0.002
Hepatorenal syndrome	11 (6.32)	10 (8.77)	1 (1.67)	3.351	0.100
Gastrointestinal hemorrhage	11 (6.32)	10 (8.77)	1 (1.67)	3.351	0.100
ACLF-1	41 (23.56)	15 (13.16)	26 (43.33)	19.874	0.000
ACLF-2	51 (29.31)	31 (27.19)	20 (33.33)	0.715	0.398
ACLF-3	82 (47.13)	68 (59.65)	14 (23.33)	20.806	0.000
INR	2.09 (1.07)	2.215 (1.24)	1.835 (0.695)	-3.193	0.001
ALB (g/L)	32.38 ± 5.31	31.42 ± 4.63	34.197 ± 6.06	-3.110	0.002
Cr (μmol/L)	55.65 (35.425)	57.20 (41.175)	55.00 (25.525)	-1.604	0.109
Na (mmol/L)	138.20 (6.52)	137.25 (7.95)	139.1 (5.325)	-2.752	0.006
WBC (G/L)	5.375 (3.623)	6.32 (4.07)	4.64 (3.085)	-3.655	0.000
NE%	69.85 (16.55)	72.95 (13.875)	63.15 (12.95)	-4.300	0.000
ALT (U/L)	379.50 (842.25)	305.5 (608.75)	793.5 (867.5)	-4.050	0.000
AST (U/L)	260.50 (591)	224.5 (342.5)	599.0 (858.25)	-4.001	0.000
TBIL (μmol/L)	260.16 ± 128.63	277.2 ± 134.7	227.8 ± 110.13	2.599	0.010
PT (S)	23.30 (11.325)	25.20 (14.3)	21.15 (7.15)	-2.956	0.003
MELD	20.58 ± 8.52	22.33 ± 8.92	17.25 ± 6.58	4.267	0.000
MELD-Na	22.51 ± 10.44	25.09 ± 11.14	17.6 ± 6.7	5.525	0.000
iMELD	38.81 ± 10.87	41.74 ± 11.38	33.23 ± 7.05	6.076	0.000
ALBI	-1.205 ± 0.53	-1.103 ± 0.45	-1.399 ± 0.613	3.293	0.001
CTP	11.00 (2)	12.00 (2)	10.00 (2.75)	-4.896	0.000

TBIL: Total bilirubin; PT: Prothrombin time; WBC: White blood cells; NE%: Percentage of neutrophils; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin. INR: Standardized international ratio; Cr: Creatinine; Na: Sodium; CTP: Child-Turcotte-Pugh; MELD: Model for End-Stage Liver Disease; MELD-Na: MELD-sodium; iMELD: Integrated MELD; ALBI: Albumin-bilirubin; ACLF-1: Acute-on-chronic liver failure grade 1; ACLF-2: Acute-on-chronic liver failure grade 2; ACLF-3: Acute-on-chronic liver failure grade 3.

Table 2 Positivity rate among 188 cultured samples

	Samples	Positive samples	Positive rate (%)
Ascites	63	3	4.76
Sputum	44	23	52.27
Blood	39	3	7.69
Urine	19	4	21.05
Throat swab	10	5	50
Stool	10	0	0
Bone marrow	2	0	0
Other secretion	1	1	100
Total	188	39	20.74

Table 3 Distribution of bacteria and fungi and source of specimens

	Total	constituent ratio (%)	Source of specimens (n = 41)
	Total	constituent ratio (%)	Ascites	Sputum	Blood	Urine	Throat swab	Other secretion
Escherichia coli	3	7.32	2	0	0	1	0	0
Enterococcus faecium	2	4.88	1	0	0	1	0	0
Klebsiella pneumoniae	4	9.76	0	4	0	0	0	0
Acinetobacter baumannii	2	4.88	0	2	0	0	0	0
Enterobacter aerogenes	3	7.32	0	2	0	0	1	0
Staphylococcus aureus	2	4.88	0	1	1	0	0	0
Klebsiella ozaenae	1	2.44	0	1	0	0	0	0
Enterococcus faecalis	1	2.44	0	0	1	0	0	0
Streptococcus haemolyticus	1	2.44	0	0	1	0	0	0
Streptococcus agalactiae	1	2.44	0	0	0	1	0	0
Staphylococcus haemolyticus	1	2.44	0	0	0	0	0	1
yeast-like fungi	8	19.51	0	6	0	1	1	0
Candida	11	26.83	0	8	0	0	3	0
Aspergillus fumigatus	1	2.44	0	1	0	0	0	0

Table 4 Risk factors for the development of bacterial and/or fungal infections

		Total	Secondary infectionn (%)	χ²	OR (95%CI)	P-value
Gender	Female	36	32 (88.89)	9.263	5.46 (1.83, 16.31)	0.002
	Male	138	82 (59.42)
Age (yr)	≥ 45	107	80 (74.77)	10.214	2.88 (1.51, 5.49)	0.001
	< 45	67	34 (50.75)
HBVDNA (IU/mL)	< 4.575 × 10⁵	79	59 (74.68)	6.281	2.32 (1.20, 4.46)	0.012
	≥ 4.575 × 10⁵	95	55 (57.89)
Stage of liver failure	Middle and late	131	102 (77.9)	30.459	9.09 (4.15, 19.89)	0.000
	Early	43	12 (27.91)
ACLF grade	ACLF-1	41	15 (36.59)	18.117	5.05 (2.40, 10.64)	0.000
	ACLF-(2, 3)	133	99 (74.44)
ALT (U/L)	< 493.5	97	75 (78.95)	15.273	3.71 (1.92, 7.17)	0.000
	≥ 493.5	77	39 (50.65)
AST (U/L)	<538.5	120	92 (76.67)	19.847	4.78 (2.40, 9.51)	0.000
	≥ 538.5	54	22 (40.74)
TBIL (µmol/mL)	≥ 348.35	40	34 (85)	7.925	3.83 (1.50, 9.73)	0.005
	< 348.35	134	80 (59.7)
WBC (G/L)	≥ 10	24	24 (100)	7.099	15.73 (2.07, 119.45)	0.008
	< 10	150	90 (60)
NE%	> 70	86	71 (82.56)	20.283	4.95 (2.47, 9.94)	0.000
	≤ 70	88	43 (48.86)
Hospital stay (d)	≥ 30	48	40 (83.33)	9.312	1.45 (0.66, 3.17)	0.003
	< 30	126	74 (58.73)
ALB (g/L)	≤ 33.1	101	76 (75.25)	9.812	2.80 (1.47, 5.33)	0.002
	> 33.1	73	38 (52.05)
PT (s)	≥ 27.55	58	48 (82.76)	10.685	3.64 (1.68, 7.89)	0.001
	< 27.55	116	66 (56.89)

TBIL: Total bilirubin; PT: Prothrombin time; WBC: White blood cells; NE%: Percentage of neutrophils; ALT: Alanine aminotransferase; ALB: Albumin. AST: Aspartate aminotransferase; ACLF grade: Acute-on-chronic liver failure grade; ACLF-1: Acute-on-chronic liver failure grade 1; ACLF-(2, 3): Acute-on-chronic liver failure grades 2 and 3.

Table 5 Correlation of grades of acute-on-chronic liver failure and liver failure scores with bacterial and/or fungal infections

	Total, n	Infection, n(%)	No infection n (%)	Corelation coefficient	Sig	χ²	P-value
ACLF grade	174	114	60	0.365	0.000	26.697	0.000
ACLF-1	41	15 (36.59)	26 (63.41)
ACLF-2	51	31 (60.78)	20 (39.22)
ACLF-3	82	68 (82.93)	14 (17.07)
MELD	174	114	60	0.285	0.001	15.421	0.001
< 20	87	46 (52.87)	41 (47.13)
20-29	62	45 (72.58)	17 (27.42)
30-39	21	19 (90.48)	2 (9.52)
≥ 40	4	4 (100)	0
MELD-Na	174	114	60	0.294	0.001	16.475	0.001
< 25	121	69 (57.02)	52 (42.98)
25-34	31	23 (74.19)	8 (25.81)
35-44	17	17 (100)	0
≥ 45	5	5 (100)	0
iMELD	174	114	60	0.368	0.000	27.181	0.000
< 30	32	15 (46.88)	17 (53.12)
30-39	74	39 (52.7)	35 (47.3)
40-49	41	34 (82.93)	7 (17.07)
50-59	20	19 (95)	1 (5)
≥ 60	7	7 (100)	0
ALBI	174	114	60	0.215	0.015	8.454	0.015
≤ -2.60	4	1 (25)	3 (75)
-2.60~-1.39	49	26 (53.06)	23 (46.94)
> -1.39	121	87 (71.9)	34 (28.1)
CTP	174	114	60	0.257	0.000	12.301	0.000
5-9	33	13 (39.4)	20 (60.6)
≥ 10	141	101 (71.63)	40 (28.37)

CTP: Child-Turcotte-Pugh; MELD: Model for End-Stage Liver Disease; MELD-Na: MELD-sodium; iMELD: Integrated MELD; ALBI: Albumin-bilirubin; ACLF grade: Acute-on-chronic liver failure grade; ACLF-1: Acute-on-chronic liver failure grade 1; ACLF-2: Acute-on-chronic liver failure grade 2; ACLF-3: Acute-on-chronic liver failure grade 3.

Citation: Wang C, Ma DQ, Luo S, Wang CM, Ding DP, Tian YY, Ao KJ, Zhang YH, Chen Y, Meng ZJ. Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure. World J Clin Cases 2019; 7(16): 2204-2216
URL: https://www.wjgnet.com/2307-8960/full/v7/i16/2204.htm
DOI: https://dx.doi.org/10.12998/wjcc.v7.i16.2204