Prognosis analysis of liver failure with secondary infection

Objective To analyze the impact of secondary infection on prognosis of liver failure. Methods A total of 384 hospitalized patients who were diagnosed with liver failure from January 2015 to Decembet 2017 in the Department of Infectious Diseases of the Second Xiangya Hospital of Central South University were retrospectively analyzed. The patients were divided into infected group and non-infected group according to whether they were complicated with infection during hospitalization. The cause of liver failure, the area and source of infection were recorded. The infected group was divided into bacterial group and fungal group. The liver and kidney function, international normalized ratio (INR). The model for end-stage liver disease (MELD) score, hospitalization days, medical expenditure, and mortality were calculated and evaluated.T test was used for normally distributed continuous variables, and chi-square test was used for classified variables. Results A total of 384 hospitalized patients with liver failure were enrolled, including 321 males and 63 females with age of (45.5±13.4) years. There were 240 patients (62.5%, infected group) who had secondary infection during the whole course, and 144 patients (37.5%, non-infected group) were not infected.Among the 384 patients, 328 patients (85.4%) were infected with hepatitis B virus, 8(2.1%) with hepatitis C virus, and 10(2.6%) with alcoholic hepatitis. As for the clinical types of liver failure, 187 patients (48.7%) were diagnosed with acute-on-chronic (subacute) liver failure and 158 (41.1%) with chronic liver failure.Among the 240 patients in the infected group, 122 patients (50.8%) had abdominal infection, 84 (35%) had pulmonary infection, 8(3.3%) had urinary tract infection, 13(5.4%) had biliary tract infection, and 11(4.6%) had bloodstream infection.The levels of total bilirubin, creatinine, MELD scores, hospitalization days and medical expenditure in the infected group and non-infected group were statistically significant (all P<0.01) after 30 days in hospital.In the infected group, 362 various samples from 240 patients were submitted for bacterial culture, among which 87 samples were positive, including Candida in 15 samples, Aspergillus in 8 samples, Acinetobacter baumannii in 13 samples, Staphylococcus in 10 samples, Escherichia coli in 11 samples, Klebsiella pneumoniae in 14 samples, Bacillus faecalis in 4 samples, Bacillus pallid in 4 samples, Stenotrophomonas maltophilia in 4 samples and Aeromonas hydrophila in 4 samples.Among the 240 patients in the infected group, 182 patients were diagnosed with bacterial infection and 58 with fungal infection. There were significant differences in total bilirubin, serum creatinine, INR, MELD scores and mortality rate between the two groups (all P<0.05). Conclusions The rate of secondary infection in patients with liver failure is not related with age. The development of secondary infection, especially fungal infection, worsens the prognosis of patients with liver failure. Key words: Liver failure; Infections; Fungus; Bacteria; Prognosis