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Volume 40 Issue 4
Apr.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(4): 760-766

Clinical features and early warning indicators of patients with acute-on-chronic liver failure and bacterial infection

DOI: 10.12449/JCH240419

  • Department of Infectious Diseases，The Second Affiliated Hospital of Air Force Medical University，Xi’an 710038，China

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  • Corresponding author: LIAN Jianqi， lianjq@fmmu.edu.cn （ORCID： 0000-0002-5549-7590）
  • Received Date: 2023-07-19
  • Accepted Date: 2023-08-18
  • Published Date: 2024-04-25
    Abstract
  •   Objective  To investigate the clinical features of patients with acute-on-chronic liver failure （ACLF） and bacterial infection and early warning indicators associated with multidrug-resistant infections.  Methods  A retrospective analysis was performed for 130 patients with ACLF and bacterial infection who attended The Second Affiliated Hospital of Air Force Medical University from January 1， 2010 to December 31， 2021， and according to the drug susceptibility results， the patients were divided into multidrug-resistant （MDR） bacterial infection group with 80 patients and non-MDR bacterial infection group with 50 patients. General information and laboratory examination results were compared between the two groups to screen for the early warning indicators associated with MDR bacterial infection. The Student’s t-test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The binary logistic regression analysis and the receiver operating characteristic （ROC） curve were used to assess the predictive value of early warning indicators.  Results  Among the 130 patients with ACLF and bacterial infection， sputum （27.7%） was the most common specimen for detection， followed by blood （24.6%）， urine （18.5%）， and ascites （17.7%）. Bacterial infections were dominated by Gram-negative bacteria （58.5%）. Of all bacteria， Escherichia coli （18.5%）， Klebsiella pneumoniae （14.6%）， and Enterococcus faecium （13.8%） were the most common pathogens. Gram-positive bacteria had a high resistance rate to the antibacterial drugs such as erythromycin （72.2%）， penicillin （57.4%）， ampicillin （55.6%）， and ciprofloxacin （53.7%）， while Gram-negative bacteria had a high resistance rate to the antibacterial drugs such as ampicillin （73.3%）， cefazolin （50.0%）， and cefepime （47.4%）. The patients with ACLF and bacterial infection had a relatively high rate of MDR bacterial infection （61.5%）. Comparison of clinical data between the two groups showed that compared with the patients with non-MDR bacterial infection， the patients with MDR bacterial infection had significantly higher levels of alanine aminotransferase （Z=2.089， P=0.037）， aspartate aminotransferase （Z=2.063， P=0.039）， white blood cell count （Z=2.207， P=0.027）， and monocyte count （Z=4.413， P<0.001）. The binary logistic regression analysis showed that monocyte count was an independent risk factor for MDR bacterial infection （odds ratio=7.120， 95% confidence interval ［CI］： 2.478‍ ‍—‍ ‍20.456，P<0.001） and had an area under the ROC curve of 0.686 （95%CI： 0.597‍ ‍—‍ ‍0.776） in predicting ACLF with MDR bacterial infection（P<0.001）， with the optimal cut-off value of 0.50×109/L， a sensitivity of 0.725， and a specificity of 0.400.  Conclusion  ACLF combined with bacterial infections is mainly caused by Gram-negative bacteria， with the common pathogens of Escherichia coli and Klebsiella pneumoniae and a relatively high MDR rate in clinical practice. An increase in monocyte count can be used as an early warning indicator to distinguish MDR bacterial infection from non-MDR bacterial infection.

     

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    • References(19)
  • [1]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35( 1): 38- 44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35( 1): 38- 44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [2]
    BI ZH, WANG LX, LIAN JQ. Definition, prognostic assessment, and advances in the diagnosis and treatment of acute-on-chronic liver failure[J]. J Clin Hepatol, 2022, 38( 7): 1671- 1676. DOI: 10.3969/j.issn.1001-5256.2022.07.041.

    毕占虎, 王临旭, 连建奇. 慢加急性肝衰竭的定义、预后评估及诊治进展[J]. 临床肝胆病杂志, 2022, 38( 7): 1671- 1676. DOI: 10.3969/j.issn.1001-5256.2022.07.041.
    [3]
    FAN Q, LI Z. Liver transplantation for acute-on-chronic liver failure[J]. Organ Transplantation, 2022, 13( 3): 333- 337. DOI: 10.3969/j.issn.1674-7445.2022.03.008.

    范祺, 李照. 慢加急性肝衰竭的肝移植治疗[J]. 器官移植, 2022, 13( 3): 333- 337. DOI: 10.3969/j.issn.1674-7445.2022.03.008.
    [4]
    MÜCKE MM, RUMYANTSEVA T, MÜCKE VT, et al. Bacterial infection-triggered acute-on-chronic liver failure is associated with increased mortality[J]. Liver Int, 2018, 38( 4): 645- 653. DOI: 10.1111/liv.13568.
    [5]
    FERNÁNDEZ J, ACEVEDO J, WIEST R, et al. Bacterial and fungal infections in acute-on-chronic liver failure: Prevalence, characteristics and impact on prognosis[J]. Gut, 2018, 67( 10): 1870- 1880. DOI: 10.1136/gutjnl-2017-314240.
    [6]
    YANG L, WU T, LI J, et al. Bacterial infections in acute-on-chronic liver failure[J]. Semin Liver Dis, 2018, 38( 2): 121- 133. DOI: 10.1055/s-0038-1657751.
    [7]
    ZHANG B, DILIHUMAER ZYE, ZHANG SY, et al. Progress on pathogenesis and medical treatment of hepatitis B virus-related chronic and acute liver failure[J/OL]. Chin J Liver Dis: Electron Version, 2023, 15( 1): 28- 33. DOI: 10.3969/j.issn.1674-7380.2023.01.005.

    张斌, 迪丽胡玛尔·扎依尔, 张诗雨, 等. 乙型肝炎相关慢加急性肝衰竭发病机制及治疗进展[J/OL]. 中国肝脏病杂志(电子版), 2023, 15( 1): 28- 33. DOI: 10.3969/j.issn.1674-7380.2023.01.005.
    [8]
    SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific association for the study of the liver(APASL): An update[J]. Hepatol Int, 2019, 13( 4): 353- 390. DOI: 10.1007/s12072-019-09946-3.
    [9]
    HUANG X, DENG ZD, NI YX, et al. Chinese experts' consensus on prevention and control of multidrug resistance organism healthcare-associated infection[J]. Chin J Infect Contr, 2015, 14( 1): 1- 9. DOI: 10.3969/j.issn.1671-9638.2015.01.001.

    黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识[J]. 中国感染控制杂志, 2015, 14( 1): 1- 9. DOI: 10.3969/j.issn.1671-9638.2015.01.001.
    [10]
    Society of Infectious Disease, Chinese Medical Association. Expert consensus on diagnosis and treatment of end-stage liver disease complicated with infections(2021 version)[J]. J Clin Hepatol, 2022, 38( 2): 304- 310. DOI: 10.3969/j.issn.1001-5256.2022.02.010.

    中华医学会感染病学分会. 终末期肝病合并感染诊治专家共识(2021年版)[J]. 临床肝胆病杂志, 2022, 38( 2): 304- 310. DOI: 10.3969/j.issn.1001-5256.2022.02.010.
    [11]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33( 10): 1847- 1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33( 10): 1847- 1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
    [12]
    ZHANG Q, SHI BX, WU L. Characteristics and risk factors of urinary tract infection in patients with HBV-related acute-on-chronic liver failure: A retrospective study[J]. Medicine(Baltimore), 2022, 101( 28): e29913. DOI: 10.1097/MD.0000000000029913.
    [13]
    XIE YX, TU B, XU Z, et al. Bacterial distributions and prognosis of bloodstream infections in patients with liver cirrhosis[J]. Sci Rep, 2017, 7( 1): 11482. DOI: 10.1038/s41598-017-11587-1.
    [14]
    LIU XQ, ZHANG XY, YING Y, et al. The role of prophylactic antibiotics in hepatitis B virus-related acute-on-chronic liver failure patients at risk of bacterial infection: A retrospective study[J]. Infect Dis Poverty, 2021, 10( 1): 44. DOI: 10.1186/s40249-021-00830-7.
    [15]
    MILOVANOVIC T, PANTIC I, VELICKOVIC J, et al. Bacteremia in patients with liver cirrhosis in the era of increasing antimicrobial resistance: Single-center epidemiology[J]. J Infect Dev Ctries, 2021, 15( 12): 1883- 1890. DOI: 10.3855/jidc.14508.
    [16]
    TREBICKA J, FERNANDEZ J, PAPP M, et al. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis[J]. J Hepatol, 2021, 74( 5): 1097- 1108. DOI: 10.1016/j.jhep.2020.11.019.
    [17]
    FERNÁNDEZ J, PRADO V, TREBICKA J, et al. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe[J]. J Hepatol, 2019, 70( 3): 398- 411. DOI: 10.1016/j.jhep.2018.10.027.
    [18]
    MAIWALL R, PASUPULETI SSR, CHANDEL SS, et al. Co-orchestration of acute kidney injury and non-kidney organ failures in critically ill patients with cirrhosis[J]. Liver Int, 2021, 41( 6): 1358- 1369. DOI: 10.1111/liv.14809.
    [19]
    LU BT, HOU YR, HU YQ, et al. Clinical analysis of serum lactate dehydrogenase, interleukin-6, procalcitonin and high-sensitivity C-reactive protein levels in evaluating the prognosis of multiple myeloma patients with bacterial infection[J/CD]. Chin J Exp Clin Infect Dis(Electronic Edition), 2023, 17( 03): 187- 193. DOI: 10.3877/cma.j.issn.1674-1358.2023.03.007.

    路炳通, 侯英荣, 胡永强, 等. 血清乳酸脱氢酶、白细胞介素6、降钙素原和超敏C反应蛋白水平变化在多发性骨髓瘤合并细菌感染者预后中的评估价值[J/CD]. 中华实验和临床感染病杂志(电子版), 2023, 17( 3): 187- 193. DOI: 10.3877/cma.j.issn.1674-1358.2023.03.007.
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