Abstract: Objective To investigate the pathogenic characteristics of pulmonary infection in hospitalized patients with hepatitis B liver failure, as well as the factors associate with poor prognosis. Methods A total of 103 patients with hepatitis B liver failure, who were hospitalized in Shuyang Hospital Affiliated to Xuzhou Medical University from January 2019 to January 2021, were selected as the study subject. All patients received routine medical support treatment and routine antiviral therapy for hepatitis B virus (HBV) after admission. After hospitalization, all patients were followed up for 1 year with regular check-ups every 3 months. The patients were divided into two groups based on their prognosis: the good prognosis group and the poor prognosis group. During hospitalization, the patient were closely monitored for the occurrence of pulmonary infection. Pathogenic culture was conducted for those who developed pulmonary infection to identify the distribution of pathogenic bacteria. Additionally, baseline data information including age, gender, body mass index, liver failure classification, presence of family history of hepatitis B, MELD score, presence of lung infection, electrolyte disorders were compared between the two groups. Laboratory indicators such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelet count (PLT), urea nitrogen (BUN), creatinine (SCR), hepatitis B virus DNA (HBV DNA) and HBeAg were also compared. Furthermore, multifactor logistic analysis was conducted to identify the risk factors associated with poor prognosis in patients. Results Among the 103 patients included in the study, 20 (19.4%) patients developed pulmonary infection during hospitalization. All 20 patients with pulmonary infection underwent pathogenic culture, and 57 strains of pathogenic bacteria were isolated. These included 8 strains of Gram positive bacteria (14.0%), 19 strains of Gram negative bacteria (33.3%), and 30 strains of fungi (52.6%). The proportion of patients aged ≥ 60 years in the poor prognosis group was significantly higher than that in good prognosis group (72.9% vs 40.9%, P<0.05). The proportion of patients with MELD score>18 in the poor prognosis group was significantly higher than that in the good prognosis group (57.6% vs 34.1%, P<0.05). The proportion of pulmonary infection in poor prognosis group was significantly higher than that in good prognosis group (30.5% vs 4.6%, P<0.05). The proportion of electrolyte disturbance in poor prognosis group was significantly higher than that in good prognosis group (25.4% vs 6.8%, P<0.05). Multivariate logistic analysis showed that age ≥ 60 years, MELD score>18, pulmonary infection, and electrolyte disorder were identified as the risk factors for poor prognosis (P<0.05). Conclusion Pulmonary infection is one of the risk factors for poor prognosis in patients with hepatitis B liver failure. Patients with pulmonary infection during hospitalization should be analyzed and treated with effective broad-spectrum antibiotics in a timely manner to improve their prognosis.

Key words: Hepatitis B liver, Liver failure, Pulmonary infection, Pathogenic bacteria, Prognosis