Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study
Abstract Objective To identify risk factors for pulmonary infection in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), assess its impact on prognosis, and develop a prognostic prediction model. Methods We retrospectively analyzed the clinical data of 393 patients...
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2025-04-01
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| Online Access: | https://doi.org/10.1186/s12890-025-03628-7 |
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| author | Neng Wang Yu Zheng Shuai Tao Liang Chen |
| author_facet | Neng Wang Yu Zheng Shuai Tao Liang Chen |
| author_sort | Neng Wang |
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| description | Abstract Objective To identify risk factors for pulmonary infection in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), assess its impact on prognosis, and develop a prognostic prediction model. Methods We retrospectively analyzed the clinical data of 393 patients with HBV-ACLF. Logistic regression was used to analyze the risk factors for lung infection in ACLF patients, as well as the factors affecting the prognosis of those who were infected. Additionally, a prognostic prediction model was established using the Nomogram method. Results The incidence of pulmonary infections in patients with ACLF was 38.7%, and patients with ACLF combined with pulmonary infections had a higher short-term mortality rate than those without infections (65.71% vs. 35.02%). Multivariate logistic regression analysis indicated that independent risk factors for pulmonary infection included TBIL, CRP, invasive procedures, peritoneal effusion, and hepatic encephalopathy. Additionally, creatinine, INR, comorbid diabetes mellitus, neutrophil counts, and lymphocyte counts were identified as independent risk factors affecting 30-day mortality in patients with pulmonary infection. Incorporating these risk factors, a new predictive model was established, with an area under the receiver operating characteristic curve of 0.832 (95% CI, 0.765-0.900). This model demonstrated higher discriminatory performance compared to traditional prognostic models such as CTP, MELD, and MELD-Na, with statistically significant differences (P < 0.05). Conclusion HBV-ACLF patients are susceptible to pulmonary infection, with fungal infection posing a significant threat. Pulmonary infection is associated with worse prognosis in HBV-ACLF patients. Early identification of risk factors and prognostic assessment can facilitate timely intervention and improve prognosis. |
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| institution | OA Journals |
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| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-e9bf3e1742af429d96bf348e171f47392025-08-20T02:24:26ZengBMCBMC Pulmonary Medicine1471-24662025-04-0125111110.1186/s12890-025-03628-7Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort studyNeng Wang0Yu Zheng1Shuai Tao2Liang Chen3Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan UniversityCenter of Infectious Disease, West China Hospital, Sichuan UniversityDepartment of Liver Disease, Shanghai Public Health Clinical Center, Fudan UniversityDepartment of Liver Disease, Shanghai Public Health Clinical Center, Fudan UniversityAbstract Objective To identify risk factors for pulmonary infection in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), assess its impact on prognosis, and develop a prognostic prediction model. Methods We retrospectively analyzed the clinical data of 393 patients with HBV-ACLF. Logistic regression was used to analyze the risk factors for lung infection in ACLF patients, as well as the factors affecting the prognosis of those who were infected. Additionally, a prognostic prediction model was established using the Nomogram method. Results The incidence of pulmonary infections in patients with ACLF was 38.7%, and patients with ACLF combined with pulmonary infections had a higher short-term mortality rate than those without infections (65.71% vs. 35.02%). Multivariate logistic regression analysis indicated that independent risk factors for pulmonary infection included TBIL, CRP, invasive procedures, peritoneal effusion, and hepatic encephalopathy. Additionally, creatinine, INR, comorbid diabetes mellitus, neutrophil counts, and lymphocyte counts were identified as independent risk factors affecting 30-day mortality in patients with pulmonary infection. Incorporating these risk factors, a new predictive model was established, with an area under the receiver operating characteristic curve of 0.832 (95% CI, 0.765-0.900). This model demonstrated higher discriminatory performance compared to traditional prognostic models such as CTP, MELD, and MELD-Na, with statistically significant differences (P < 0.05). Conclusion HBV-ACLF patients are susceptible to pulmonary infection, with fungal infection posing a significant threat. Pulmonary infection is associated with worse prognosis in HBV-ACLF patients. Early identification of risk factors and prognostic assessment can facilitate timely intervention and improve prognosis.https://doi.org/10.1186/s12890-025-03628-7Hepatitis BAcute-on-chronic liver failurePulmonary infectionRisk factorsPrediction model |
| spellingShingle | Neng Wang Yu Zheng Shuai Tao Liang Chen Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study BMC Pulmonary Medicine Hepatitis B Acute-on-chronic liver failure Pulmonary infection Risk factors Prediction model |
| title | Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study |
| title_full | Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study |
| title_fullStr | Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study |
| title_full_unstemmed | Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study |
| title_short | Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study |
| title_sort | risk factors and prognosis of pulmonary infection in hepatitis b related acute on chronic liver failure a retrospective cohort study |
| topic | Hepatitis B Acute-on-chronic liver failure Pulmonary infection Risk factors Prediction model |
| url | https://doi.org/10.1186/s12890-025-03628-7 |
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