HBV相关慢加急性肝衰竭患者感染危险因素及其对预后影响

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

HBV相关慢加急性肝衰竭患者感染危险因素及其对预后影响

黄翀, 钟启盛, 鱼康康, 刘传苗

200040 上海复旦大学附属华山医院感染科(黄翀,鱼康康);兴国县人民医院感染科(钟启盛);蚌埠医学院第一附属医院感染科(刘传苗)

收稿日期:2021-07-03 出版日期:2022-02-28 发布日期:2022-04-19
通讯作者: 刘传苗,Email: liuchuanmiao119@sina.com
基金资助:
国家自然科学基金(82000576)

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. 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

摘要/Abstract

摘要： 目的探索HBV相关慢加急性肝衰竭感染发生危险因素及其对预后的影响。方法回顾性分析2007年至2016年华山医院感染科收治的HBV相关ACLF患者的临床资料,分析其不同类型感染的发生率和危险因素以及感染对60 d生存的影响。结果共纳入293例HBV相关慢加急性肝衰竭患者,其中92例符合欧洲肝病学会CLIF-C 2-3级ACLF标准。CLIF-C 2-3级患者60 d总体感染发生率为54%,高于0-1级的34%(P=0.001)。共有162例ACLF患者病程中使用糖皮质激素,其肺部感染、真菌/其他机会性感染、全部感染发生率高于未使用激素者,为19%比7%、7%比0以及54%比24%,差异均有统计学意义(均P<0.01)。Cox多因素分析发现,糖皮质激素治疗是全部感染、肺部感染和真菌/其他机会性感染发生的独立危险因素。CLIF 0-1级发生感染者比未感染者60 d生存率更低(58%比77%,P=0.005),但CLIF 2-3级发生感染者与未感染者60 d生存率无明显差异。单因素分析中,年龄≥45岁、基线CLIF等级为2-3、肺部感染和全部感染是60 d死亡的危险因素,在多因素分析中仅年龄≥45岁(HR 1.585,95%CI:1.183~2.591)和基线ACLF等级为2-3(HR 2.542,95%CI:1.427~3.673)是60 d死亡的独立危险因素。结论 HBV相关ACLF患者感染发生率较高,感染的主要危险因素是糖皮质激素使用,CLIF 0-1级发生感染者生存下降。

关键词: 慢加急性肝衰竭, 感染, 乙型肝炎病毒, 预后

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

黄翀, 钟启盛, 鱼康康, 刘传苗. HBV相关慢加急性肝衰竭患者感染危险因素及其对预后影响[J]. 肝脏, 2022, 27(2): 148-151.

HUANG Chong, ZHONG Qi-sheng, YU Kang-kang, LIU Chuan-miao. Risk factors of infection in patients with HBV-related ACLF and its influence on prognosis[J]. Chinese Hepatolgy, 2022, 27(2): 148-151.

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