Chinese Hepatolgy ›› 2021, Vol. 26 ›› Issue (8): 892-894.

• Liver Failure • Previous Articles     Next Articles

A comparison between the effects of antibiotic de-escalation therapy and empirical treatment on HBV-related acute-on-chronic liver failure patients complicated with spontaneous bacterial peritonitis

HAN Xian-zhi, ZHANG Shu-feng, GAO Guang-fu, ZHU Hai-yang, GAO Hong-wei, SUN Hui-qing   

  1. Department No.3 Digestive Department,The Fifth Affiliated Hospital of Zhengzhou University, Henan 450052, China
  • Received:2020-09-19 Online:2021-08-31 Published:2021-09-29
  • Contact: ZHANG Shu-feng,Email:sufei_zhang@126.com

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Abstract: Objective To study on the effect of antibiotic de-escalation therapy and empirical treatment on HBV-related acute-on-chronic liver failure (HBV-ACLF) patients complicated with spontaneous bacterial peritonitis (SBP).Methods A total of 104 patients with HBV-ACLF and SBP from April 2014 to April 2020 were enrolled in this study. They were divided into an observation group and a control group by random number table method, with 52 cases in each group. The observation group was treated with antibiotic de-escalation and further divided into effective and non-effective subgroups, while the control group was treated with empirical antibiotic therapy. The ascites bacterial culture results were recorded and the therapeutic effects of these groups were compared. Factors associated with the treatment effect were analyzed.Results There was significant difference between the observation and control groups in overall efficacy after 2 weeks’ treatment (P<0.05). The incidence of hepatic encephalopathy and refractory ascites in the observation group were significantly lower than those of the control group ((13 vs 23 cases, and 11 vs 21 cases, respectively) (P<0.05). In patients of the observation group, the international normalized ratio (INR), levels of aspartate aminotransferase (AST) and alanine transferase (ALT), the model for end stage liver disease (MELD) score of effectively treated patients were significantly lower than those of non-effective patients (P<0.05). By multivariate logistic regression analysis it was showed that the hepatic encephalopathy (95%CI=1.154～9.328, P=0.026, OR=3.281), hepatorenal syndrome (95%CI=1.522～4.087, P=0.000, OR=2.494), international normalized ratio (INR) (95%CI=1.375～2.603, P=0.000, OR=1.892), model for end-stage liver disease (MELD)(95%CI=1.054-3.630, P=0.033, OR=1.956) were independent factors influencing the treatment effect on patients with HBV-ACLF and SBP.Conclusion Antibiotic de-escalation regimen for the treatment of HBV-ACLF combined with SBP is more effective than conventional empirical antibiotic therapy. This efficacy is further associated with factors such as INR, MELD and hepatic encephalopathy.

Key words: Antibiotic de-escalation, Empirical antibiotic therapy, HBV-related acute-on-chronic liver failure, Spontaneous bacterial peritonitis