The impact of HBV flare on the outcome of HBV‐related decompensated cirrhosis patients with bacterial infection. (10th July 2019)

• Record Type: Journal Article
• Authors: Cao, Zhujun; Liu, Yuhan; Wang, Shijin; Lu, Xiaobo; Yin, Shan; Jiang, Shaowen; Chen, Liuying; Cai, Minghao; Zeng, Bo; Yao, Yujing; Tang, Weiliang; Zhao, Gangde; Xiang, Xiaogang; Wang, Hui; Cai, Wei; Zhu, Chuanwu; Li, Hai; Xie, Qing
• Is Part Of: Liver international. Volume 39:Number 10(2019)
• Page Start: 1943
• Page End: 1953
• Publication Date: 2019-07-10
• Subjects: acute‐on‐chronic liver failure -- bacterial infection -- decompensation -- HBV flare -- organ failure; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.14176
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background: Hepatitis B virus (HBV) flare can occur in HBV patients either naïve or have interruption to treatment. Bacterial infection (BI) is a common complication of cirrhosis with potential severe outcomes. We aimed to assess the impact of HBV flare on the outcome of patients with HBV‐related decompensated cirrhosis and BI. Methods: This was a retrospective study from 2 tertiary academic hospitals in Shanghai, China of HBV patients admitted with or developed BI during admission. The characteristics of BI, prevalence of HBV flare, its impact on organ failure, acute‐on‐chronic liver failure (ACLF) and 90‐day survival were evaluated. Results: A total of 360 hospitalized patients (median age: 50 years, male: 79%, BI: at admission: 58.6%; during admission: 41.4%) were included. All patients including those with HBV flare (21%) received antiviral therapy after admission. Patients with HBV flare and BI had significantly higher percentage of liver (93.3% vs 48.8%), coagulation (64.0% vs 39.6%), cerebral (40.0% vs 21.8%) (all P < 0.01), and kidney failure (38.7% vs 26.3%, P < 0.05) compared to BI alone, associated with a higher risk of developing ACLF with a subdistribution hazard ratio (sHR) of 2.23 (95% confidence interval [CI]: 1.68‐2.96). Multivariate analysis showed that ACLF development was the strongest risk factor for 90‐day mortality (sHR, 95%CI: 7.36, 4.12‐13.16). Conclusions: In HBV‐related decompensated cirrhosis patients admitted with BI, HBV flare increased the risk of additional organ failures and ACLF, raising the risk of 90‐day mortality by seven‐fold. Optimization of HBV treatment in these patients should minimize the risk of HBV flare with improved outcomes.