Risk factors of invasive pulmonary aspergillosis in patients with Hepatitis B virus-related acute-on-chronic liver failure

Abstract

Abstract:

Objective To investigate the incidence, risk factors and prognosis of invasive pulmonary aspergillosis (IPA) in patients with Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The clinical data of 283 patients with Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) who were hospitalized in our department from January 2015 to January 2017 were recorded. All patients were divided into IPA group and control group according to the status of invasive pulmonary aspergillosis during hospitalization. Results Among the 283 patients with hepatitis B virus-related acute-on-chronic liver failure, 39 cases of definite or probable pulmonary aspergillosis were diagnosed during hospitalization, the incidence was 13.78% (39/283). There were statistically differences (P<0.05) between pulmonary aspergillosis group and control group in type 2 diabetes mellitus, pulmonary underlying diseases, admission baseline TBiL level, MELD score, usage of glucocorticoid, usage of broad-spectrum potent antibiotic, femoral vein catheterization, hospital floor comparison. Logistic regression analysis showed that the risk factors of pulmonary aspergillosis in patients with HBV-ACLF were type 2 diabetes mellitus (OR=8.981,P=0.002), pulmonary basal disease (OR=8.525,P=0.000), usage of glucocorticoid (OR=8.856, P=0.000), usage of broad-spectrum potent antibiotics (OR=9.823,P=0.000). Thirty-one patients with HBV-ACLF and secondary IPA died, the mortality rate was 79.48% (31/39). Conclusion The hospitalized hepatitis B virus related acute-on-chronic liver failure patients were predisposed to invasive pulmonary aspergillosis. Type 2 diabetes mellitus, pulmonary underlying diseases, usage of corticosteroids or broad spectrum antibiotics might be risk factors for pulmonary aspergillosis. Once HBV-ACLF patients complicated with IPA, they might have a poorer prognosis.

Key words: liver failure, invasive pulmonary aspergillosis, HBV, risk factor

CLC Number:

R519.8

LI Ming, WU Zhen-ping, CHENG Xiao-yu, YU Ting-ting, LI Xiao-peng, ZHANG Lun-li, ZHANG Wen-feng. Risk factors of invasive pulmonary aspergillosis in patients with Hepatitis B virus-related acute-on-chronic liver failure[J]. Chinese Journal of Mycology, 2018, 13(4): 213-216,228.

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