Bacterial infection is a risk factor for progression to acute-on-chronic liver failure in patients with severe hepatitis flare of HBV-related compensated liver cirrhosis

Abstract Aims The aims of this study were to investigate the risk factors for bacterial infection (BI) and the association of BI with progression to acute-on-chronic liver failure (ACLF) in patients with severe hepatitis flare of hepatitis B virus (HBV)-related compensated liver cirrhosis. Methods 237 patients with HBV-related compensated liver cirrhosis and severe hepatitis flare were retrospectively reviewed. Baseline demographics characteristics, biochemical were compared between patients with and without occurring of BIs and progression to ACLF. Univariate and multivariate logistic regression were used to identify independent risk factors associated with development of BI and ACLF. Results 48 (20.3%) patients progressed to ACLF after admission. 101 (42.6%) patients progressed to hepatic decompensation (HD) and 52 (20.3%) patients had BIs before development of ACLF. Patients with BIs had significantly higher incidence of HD (73.1%) and ACLF (46.2%) than those without BIs (34.1% and 13.0%, respectively, P < 0.01). Total bilirubin (TBil, OR = 1.003, 95% CI: 1.000-1.006) and Child-turcotte-pugh (CTP) score (OR = 1.745, 95% CI: 1.345–2.265) were identified as independent risk factors associated with BI. BI (OR = 7.113, 95% CI: 2.714–18.644), gamma-glutamyl transpeptidase (OR = 0.094, 95% CI: 0.988–0.999), TBil (OR = 1.004, 95% CI: 1.001–1.007), international normalized ratio (OR = 114.05, 95% CI:17.4-746.3) and platelet (OR = 0.984, 95% CI: 0.972–0.996) were independent risk factors associated with progression to ACLF. Conclusion High level of TBil and CTP score are risk factors associated with occurring of BI and BI is a risk factor related with progression to ACLF in patients with HBV-related compensated liver cirrhosis and severe hepatitis flare.