传染病信息

目的 分析慢加急性肝衰竭(acute-on-chronic liver failure, ACLF)合并感染患者的临床特征和发生死亡的危险因素。方法 纳入2018年1月至2024年6月西京医院和唐都医院收治的ACLF合并感染的患者，回顾性分析患者人口学资料、基础疾病、实验室检查指标及临床转归等特征，比较随访3个月后生存组和死亡组的临床特征。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验，计数资料采用χ²检验。单因素和多因素Logistic逐步回归模型分析死亡风险因素。受试者工作特征曲线和曲线下面积评估预测效能。结果 共纳入245例ACLF合并感染患者，男性166例，女性79例，平均年龄为(48.40±13.61)岁，肝衰竭1级84例、2级81例、3级80例。合并乙型肝炎病毒感染155例，合并肝硬化183例。合并上消化道出血15例、肝性脑病104例、腹水205例。进行侵入性操作包括胃肠减压31例、吸痰22例、气管插管6例、留置导尿管75例、股静脉置管81例、中心静脉置管13例、动脉置管100例。随访3个月后，201例生存，44例死亡，病死率为17.96%。死亡组肝硬化比例(59.09%vs. 78.11%)、动脉置管比例(25.00%vs. 44.28%)、凝血酶原活动度水平[22.90(16.80, 28.30)%vs. 32.30(22.30, 39.50)%]低于生存组(均P<0.05)，死亡组肝衰竭3级、合并肝性脑病、气管插管、留置导尿管的病例数，白细胞计数、中性粒细胞计数、总胆红素、肌酐、国际标准化比值、Child-Pugh评分、终末期肝病模型(model for end-stage liver disease, MELD)评分、MELD-Na评分高于生存组(均P<0.05)。多因素Logistic回归分析显示，合并肝硬化[比值比(odd ratio, OR)=0.233]是ACLF合并感染患者死亡风险的保护性因素，合并肝性脑病(OR=5.199)、留置导尿管(OR=2.639)、总胆红素升高(OR=1.005)是ACLF合并感染患者死亡的危险因素。Child-Pugh评分、MELD评分、MELD-Na评分对死亡结局预测效能均较好(均P<0.05)。结论 合并肝性脑病、留置导尿管、总胆红素升高是ACLF合并感染患者死亡的独立危险因素。

Objective To analyze the clinical characteristics and fatality risk factors for patients with acute-on-chronic liver failure(ACLF) complicated with infection. Methods ACLF patients complicated with infection were enrolled from Xijing Hospital and Tangdu Hospital from January 2018 to June 2024. The demographic data, underlying diseases, laboratory indicators, and clinical outcomes of enrolled patients were retrospectively analyzed. Continuous variables were compared using the independent t-test or Mann-Whitney U test, while categorical variables were compared using the chi-square test.. The fatality risk factors were examined using univariate and multivariate stepwise logistic regression models. Receiver operating characteristic curves and area under the curve were used to assess the predictive performance. Results A total of 245 ACLF patients complicated with infection were enrolled, including 166 males and 79 females. The average age was(48.40±13.61) years. There were 84 cases of grade 1, 81 cases of grade 2, and 80 cases of grade 3 liver failure. 155 patients had the underlying disease of hepatitis B virus infection, while 183 patients had liver cirrhosis. There were 15 patients complicated with upper gastrointestinal bleeding, 104 with hepatic encephalopathy, and 205 with ascites. Invasive operations included gastrointestinal decompression(n=31), sputum suction(n=22), trachea cannula(n=6), indwelling catheter(n=75), femoral vein catheterization(n=81), central venous catheterization(n=13), and arterial catheterization(n=100). 201 patients survived, while 44 patients died after 3 months followed-up, leading to the fatality rate of 17.96%. The percentage of liver cirrhosis(59.09% vs. 78.11%), arterial catheterization(25.00% vs. 44.28%), and prothrombin activity levels [22.90(16.80, 28.30)% vs. 32.30(22.30, 39.50)%] were lower in death group compared with survival group(P<0.05). The percentage of grade 3 liver failure, complicated with hepatic encephalopathy, trachea cannula, indwelling catheter, white blood cell counts, neutrophils counts, total bilirubin levels, creatinine levels, international normalized ratios, Child-Pugh scores, model for end-stage liver disease(MELD) scores, and MELD-Na scores were higher in death group compared with survival group(P<0.05). The multivariate logistic analysis revealed that complicated with liver cirrhosis [odd ratio(OR)=0.233] was the protective factor, while complicated with hepatic encephalopathy(OR=5.199), indwelling catheter(OR=2.639), and increased total bilirubin(OR=1.005) were the risk factors for ACLF patients complicated with infection fatality. Child-Pugh score, MELD score and MELD-Na score all had good predictive efficacy for the death outcome(P<0.05). Conclusion Complicated with hepatic encephalopathy, indwelling catheter, and elevation of total bilirubin are independent fatality risk factors for ACLF patients complicated with infection.