The impact of HBV flare on the outcome of HBV-related decompensated cirrhosis patients with bacterial infection
The impact of HBV flare on the outcome of HBV-related decompensated cirrhosis patients with bacterial infection
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HBV 急性发作对 HBV 相关失代偿性肝硬化合并细菌感染患者预后的影响
DOI：
10.1111/liv.14176
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发表时间：
2019-07-10
影响因子：
6.7
通讯作者：
Xie, Qing
中科院分区：
文献类型：
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作者：
Cao, Zhujun;Liu, Yuhan;Xie, Qing
背景 乙型肝炎病毒 (HBV) 发作可能发生在初治或中断治疗的 HBV 患者中。细菌感染（BI）是肝硬化的常见并发症，具有潜在的严重后果。我们的目的是评估 HBV 急性发作对 HBV 相关失代偿性肝硬化和 BI 患者预后的影响。方法 这是对中国上海 2 家三级甲等医院入院时患有或在入院时出现 BI 的 HBV 患者进行的回顾性研究。评估了 BI 的特征、HBV 发作的患病率、其对器官衰竭、慢加急性肝衰竭 (ACLF) 和 90 天生存率的影响。结果 共纳入360例住院患者（中位年龄：50岁，男性：79%，BI：入院时：58.6%；入院期间：41.4%）。所有患者，包括乙型肝炎发作患者（21%），在入院后均接受了抗病毒治疗。与单独使用 BI 相比，患有 HBV 发作和 BI 的患者的肝脏（93.3% vs 48.8%）、凝血（64.0% vs 39.6%）、大脑（40.0% vs 21.8%）（均 P < 0.01）和肾衰竭（38.7% vs 26.3%，P < 0.05）的百分比显着较高，与发生 ACLF 的风险较高相关。次分布 风险比 (sHR) 为 2.23（95% 置信区间 [CI]：1.68-2.96）。多变量分析显示，ACLF 的发生是 90 天死亡率的最强危险因素（sHR，95%CI：7.36，4.12-13.16）。结论 在因 BI 入院的 HBV 相关失代偿性肝硬化患者中，HBV 急性发作增加了其他器官衰竭和 ACLF 的风险，使 90 天死亡率风险增加了 7 倍。对这些患者进行优化的乙型肝炎治疗应能最大程度地降低乙型肝炎发作的风险，并改善预后。
Background Hepatitis B virus (HBV) flare can occur in HBV patients either naive or have interruption to treatment. Bacterial infection (BI) is a common complication of cirrhosis with potential severe outcomes. We aimed to assess the impact of HBV flare on the outcome of patients with HBV-related decompensated cirrhosis and BI. Methods This was a retrospective study from 2 tertiary academic hospitals in Shanghai, China of HBV patients admitted with or developed BI during admission. The characteristics of BI, prevalence of HBV flare, its impact on organ failure, acute-on-chronic liver failure (ACLF) and 90-day survival were evaluated. Results A total of 360 hospitalized patients (median age: 50 years, male: 79%, BI: at admission: 58.6%; during admission: 41.4%) were included. All patients including those with HBV flare (21%) received antiviral therapy after admission. Patients with HBV flare and BI had significantly higher percentage of liver (93.3% vs 48.8%), coagulation (64.0% vs 39.6%), cerebral (40.0% vs 21.8%) (all P < 0.01), and kidney failure (38.7% vs 26.3%, P < 0.05) compared to BI alone, associated with a higher risk of developing ACLF with a subdistribution hazard ratio (sHR) of 2.23 (95% confidence interval [CI]: 1.68-2.96). Multivariate analysis showed that ACLF development was the strongest risk factor for 90-day mortality (sHR, 95%CI: 7.36, 4.12-13.16). Conclusions In HBV-related decompensated cirrhosis patients admitted with BI, HBV flare increased the risk of additional organ failures and ACLF, raising the risk of 90-day mortality by seven-fold. Optimization of HBV treatment in these patients should minimize the risk of HBV flare with improved outcomes.