Published online Feb 14, 2020. doi: 10.3748/wjg.v26.i6.645
Peer-review started: November 25, 2019
First decision: December 23, 2019
Revised: January 8, 2020
Accepted: January 15, 2020
Article in press: January 15, 2020
Published online: February 14, 2020
Reports on bacterial infection (BI) in decompensated cirrhosis (DC) is mainly from alcoholic cirrhosis. The role of BI as a trigger or complication of acute-on-chronic liver failure (ACLF) in patients with hepatitis B virus decompensated cirrhosis (HBV-DC) remains to be investigated.
To investigate the impact of BI on the outcomes of the patients with HBV-DC admitted into the hospital with or without ACLF.
This retrospective study included patients with HBV-DC admitted to two tertiary centers in China. In-hospital overall survival, 90-d transplant-free survival, 5-year post-discharge survival, and cumulative incidence of ACLF were evaluated. Risk factors for death were analyzed considering liver transplantation as a competing event.
A total of 1281 hospitalized HBV-DC patients were included; 284 had ACLF at admission. The overall prevalence of BI was 28.1%. The patients with BI had a significantly lower in-hospital survival and transplant-free 90-d survival than those without, in both the patients admitted with and without ACLF. The presence of BI significantly increased the risk of developing ACLF [sub-distribution hazard ratio (sHR) = 2.52, 95%CI: 1.75-3.61, P < 0.001] in the patients without ACLF. In the patients discharged alive, those who had an episode of BI had a significantly lower 5-year transplant-free survival. BI was an independent risk factor for death in the patients admitted without ACLF (sHR = 3.28, 95%CI: 1.93-5.57), while in ACLF admissions, the presence of pneumonia, but not other type of BI, independently increased the risk of death (sHR = 1.87, 95%CI: 1.24-2.82).
BI triggers ACLF in patients with HBV-DC and significantly impairs short-term survival. HBV-DC patients should be monitored carefully for the development of BI, especially pneumonia, to avoid an adverse outcome.
Core tip: In our cohort of 1281 patients with hepatitis B virus-related decompensated cirrhosis (HBV-DC), bacterial infection (BI) significantly reduced both short-term and long-term survival independent of the presence of acute-on-chronic liver failure (ACLF) and the severity of the underlying liver disease. BI precipitated ACLF in patients admitted without this syndrome and in those with ACLF, BI was significantly associated with a reduced rate of liver transplantation. Thus, our data suggest that patients with HBV-DC should be monitored carefully for the development of BI to avoid an adverse outcome.