Invasive pulmonary aspergillosis in patients with hepatitis B virus–related acute-on-chronic liver failure

【作者】 吴振平； 章云涛；

【Author】 Wu Zhen-ping;Zhang Yun-tao;Department of Intensive Care Unit,The First Affiliated Hospital,College of Medicine,Zhejiang University;

【机构】 Department of Intensive Care Unit,The First Affiliated Hospital,College of Medicine,Zhejiang University；

【摘要】 Hepatitis B virus(HBV)is the leading cause of acute on chronic liver failure(ACLF) in China.In recent years,we observed from clinical practice that ACLF complicated with invasive pulmonary aspergillosis(IPA) is increasingly common.However,there is not enough report on ACLF combined with IPA.To investigate the incidence,risk factors,and prognosis of IPA in patients with HBV-ACLF.Clinical data of 283 patients with HBV-ACLF hospitalized in our hospital from 2015 to 2017 were recorded.Patients were divided into an IPA group and a control group according to the status of IPA during hospitalization.Data were compared between the two groups,and multivariate logistic regression models were used to demonstrate risk factors associated with IPA.Among the 283 patients with HBVACLF,39 cases of definite or probable pulmonary aspergillosis were diagnosed during hospitalization;the incidence was 13.78%(39/283).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),and use 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).Hospitalized hepatitis B virus–related acute on chronic liver failure patients are predisposed to invasive pulmonary aspergillosis.Type 2 diabetes mellitus,pulmonary underlying diseases,and use of corticosteroids or broad-spectrum antibiotics may also be risk factors for pulmonary aspergillosis.Once HBV-ACLF patients are complicated with IPA,they may have a poorer prognosis.更多还原

【Abstract】 Hepatitis B virus(HBV)is the leading cause of acute on chronic liver failure(ACLF) in China.In recent years,we observed from clinical practice that ACLF complicated with invasive pulmonary aspergillosis(IPA) is increasingly common.However,there is not enough report on ACLF combined with IPA.To investigate the incidence,risk factors,and prognosis of IPA in patients with HBV-ACLF.Clinical data of 283 patients with HBV-ACLF hospitalized in our hospital from 2015 to 2017 were recorded.Patients were divided into an IPA group and a control group according to the status of IPA during hospitalization.Data were compared between the two groups,and multivariate logistic regression models were used to demonstrate risk factors associated with IPA.Among the 283 patients with HBVACLF,39 cases of definite or probable pulmonary aspergillosis were diagnosed during hospitalization;the incidence was 13.78%(39/283).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),and use 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).Hospitalized hepatitis B virus–related acute on chronic liver failure patients are predisposed to invasive pulmonary aspergillosis.Type 2 diabetes mellitus,pulmonary underlying diseases,and use of corticosteroids or broad-spectrum antibiotics may also be risk factors for pulmonary aspergillosis.Once HBV-ACLF patients are complicated with IPA,they may have a poorer prognosis.更多还原