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
Most deaths from hepatitis B virus (HBV) infection are related to complications of cirrhosis, among which bacterial infection (BI) frequently develops in decompensated cirrhosis (DC) as reported in Western countries where alcoholic cirrhosis is frequent.
Investigation on BI in patients with HBV-DC would be particularly important in improving the current management of HBV-DC and acute-on-chronic liver failure (ACLF), especially in Asian countries where health care resources are relatively limited and access to liver transplantation is much more restricted.
To investigate the impact of BI on the outcomes of patients with HBV-DC admitted into the hospital with or without ACLF.
This retrospective study included the 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.
It is imperative to minimize/prevent the risk of BI, as this has a negative impact on patient survival, extending well into the post-discharge period. Once BI is suspected, proper antibiotic treatment should be initiated early to prevent adverse outcomes.