Table 5.
Independent predictors of 28-d outcomes in hepatitis B virus-related acute-on-chronic liver failure patients combined with bacterial infections
| Variable | Survivors (n = 58) | Nonsurvivors (n = 99) |
Univariate Cox regression |
Multivariate Cox regression |
||
| HR (95%CI) | P value | HR (95%CI) | P value | |||
| Age (yr) | 45.5 ± 9.7 | 49.3 ± 10.7 | 1.023 (1.005-1.042) | 0.013 | ||
| Male (%) | 53 (91.4) | 82 (82.8) | 0.693 (0.410-1.170) | 0.170 | ||
| Cirrhosis (%) | 50 (86.2) | 85 (85.9) | 0.956 (0.543-1.684) | 0.877 | ||
| SIRS (%) | 17 (29.3) | 58 (58.6) | 2.214 (1.480-3.310) | < 0.001 | ||
| Temperature (°C) | 37.1 (36.6, 38.0) | 37.1 (36.6, 38.0) | 1.055 (0.861-1.293) | 0.604 | ||
| MAP (mmHg) | 86.9 ± 11.4 | 88.9 ± 15.5 | 1.003 (0.987-1.019) | 0.696 | ||
| Invasive catheterization (%) | 6 (10.3) | 26 (26.3) | 2.026 (1.290-3.181) | 0.002 | 2.173 (1.320-3.579) | 0.002 |
| Grade of ACLF | ||||||
| ACLF-1 (%) | 44 (75.9) | 35 (35.4) | Reference | < 0.001 | ||
| ACLF-2 (%) | 12 (20.7) | 29 (29.3) | 1.977 (1.205-3.243) | 0.007 | ||
| ACLF-3 (%) | 2 (3.4) | 35 (35.4) | 4.648 (2.862-7.548) | < 0.001 | ||
| HBV DNA (log10 IU/ml) | 3.6 (2.3, 5.5) | 4.7 (2.8, 6.6) | 1.083 (0.997-1.177) | 0.060 | ||
| WBC (×109/L) | 7.5 (5.6, 11.3) | 10.4 (6.9, 15.0) | 1.054 (1.022-1.088) | 0.001 | ||
| NEUT (×109/L) | 5.4 (3.4, 8.6) | 8.5 (5.1, 12.7) | 1.058 (1.023-1.094) | 0.001 | ||
| HGB (g/L) | 105.0 ± 21.6 | 109.3 ± 26.3 | 1.003 (0.994-1.011) | 0.516 | ||
| PLT (×109/L) | 64.0 (46.8, 88.5) | 63.0 (40.0, 98.0) | 1.000 (0.995-1.005) | 0.984 | ||
| ALB (g/L) | 28.0 (25.0, 31.0) | 28.0 (23.0, 31.0) | 0.984 (0.945-1.024) | 0.435 | ||
| TBIL (μmol/L) | 353.6 ± 130.9 | 356.4 ± 163.7 | 1.000 (0.999-1.001) | 0.836 | ||
| DBIL (μmol/L) | 257.4 ± 88.3 | 236.8 ± 113.7 | 0.998 (0.996-1.000) | 0.091 | ||
| ALT (IU/L) | 76.5 (35.3, 127.8) | 103.0 (49.0, 352.0) | 1.001 (1.000-1.001) | 0.003 | ||
| AST (IU/L) | 118.0 (71.0, 165.0) | 136.0 (85.0, 367.0) | 1.001 (1.000-1.001) | < 0.001 | ||
| ALP (IU/L) | 158.5 (125.8, 211.3) | 137.0 (99.0, 179.0) | 1.000 (0.998-1.001) | 0.721 | ||
| GGT (IU/L) | 49.0 (35.8, 78.8) | 56.0 (33.0, 78.0) | 0.999 (0.995-1.004) | 0.821 | ||
| Cr (μmol/L) | 98.5 (79.5, 126.3) | 122.0 (87.0, 196.0) | 1.002 (1.001-1.003) | 0.001 | ||
| Na (mmol/L) | 133.0 (130.0, 136.0) | 132.0 (128.0, 136.0) | 0.996 (0.962-1.031) | 0.830 | ||
| INR | 1.9 (1.7, 2.3) | 2.6 (2.1, 3.3) | 1.762 (1.487-2.089) | < 0.001 | ||
| PTA (%) | 33.2 ± 11.1 | 23.3 ± 9.9 | 0.937 (0.917-0.957) | < 0.001 | 0.967 (0.941-0.993) | 0.015 |
| CRP (mg/L) | 20.5 (13.2, 43.4) | 16.2 (8.9, 39.6) | 0.998 (0.991-1.005) | 0.530 | ||
| PCT (ng/mL) | 1.2 (0.8, 1.8) | 1.2 (0.6, 2.9) | 1.017 (1.002-1.033) | 0.025 | ||
| Ascites (%) | 57 (98.3) | 96 (97.0) | 0.578 (0.183-1.828) | 0.351 | ||
| AKI (%) | 24 (41.4) | 61 (61.6) | 2.777 (1.734-4.449) | < 0.001 | 2.187 (1.259-3.799) | 0.005 |
| HE (%) | 23 (39.7) | 76 (76.8) | 1.635 (1.089-2.454) | 0.018 | ||
| AVB (%) | 8 (13.8) | 26 (26.3) | 1.476 (0.942-2.312) | 0.089 | ||
| Pneumonia (%) | 20 (34.5) | 59 (59.6) | 1.831 (1.222-2.744) | 0.003 | ||
| SBP (%) | 34 (58.6) | 33 (33.3) | 0.553 (0.364-0.842) | 0.006 | ||
| BSI (%) | 6 (10.3) | 20 (20.2) | 1.661 (1.016-2.715) | 0.043 | 2.339 (1.384-3.952) | 0.002 |
| Other BIs (%) | 4 (6.9) | 16 (16.2) | 1.488 (0.870-2.544) | 0.146 | ||
| Multiple sites of BIs (%) | 6 (10.3) | 24 (24.2) | 1.797 (1.132-2.852) | 0.013 | ||
| MDROs (%) | 4 (6.9) | 11 (11.1) | 1.401 (0.728-2.696) | 0.313 | ||
| CA BIs (%) | 4 (6.9) | 13 (13.1) | 1.537 (0.857-2.757) | 0.149 | ||
| HCA BIs (%) | 24 (41.4) | 47 (47.5) | 1.046 (0.705-1.553) | 0.821 | ||
| Nosocomial BIs (%) | 30 (51.7) | 39 (39.4) | 0.804 (0.537-1.204) | 0.290 | ||
| COSSH-ACLF Scores | 6.1 (5.8, 6.7) | 7.4 (6.6, 8.7) | 1.704 (1.498, 1.937) | < 0.001 | 1.371 (1.127-1.666) | 0.002 |
SIRS: Systemic inflammation response syndrome; MAP: Mean arterial pressure; ACLF: Acute-on-chronic liver failure; HBV: Hepatitis B virus; WBC: White blood cells; NEUT: Neutrophil count; HGB: Hemoglobin; PLT: Platelet; ALB: Albumin; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transpeptidase; Cr: Creatinine; Na: Sodium; INR: International normalized ratio; PTA: Prothrombin activity; CRP: C-reactive protein; PCT: Procalcitonin; AKI: Acute kidney injury; HE: Hepatic encephalopathy; AVB: Acute variceal bleed; SBP: Spontaneous bacterial peritonitis; BSI: Bloodstream infection; BIs: Bacterial infections; MDROs: Multidrug-resistant organisms; CA: Community-acquired; HCA: Healthcare-associated; COSSH: Chinese Group on the Study of Severe Hepatitis B.