Abstract

Acute-on-chronic liver failure (ACLF) is a severe syndrome characterized by acute decompensation (AD), organ failures, and high short-term mortality. Once patients with AD or ACLF have complications with invasive fungal infection (IFI), the mortality rate further increases. In this study, a total of 1636 patients with AD of cirrhosis diagnosed between January 2008 and December 2017 were enrolled in the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China. Of the 1636 patients with AD of cirrhosis, 191 were complicated by IFI and their epidemiological characteristics were investigated. Cox proportional hazards regression was performed to analyze the factors impacting a 28-day survival in AD or ACLF with IFI. The findings indicated that the incidence of IFI in patients with AD of cirrhosis was 13.5%; the most common source of infection is pneumonia; the most common strain of fungi was Candida albicans, followed by Aspergillus fumigatus. Further, IFI is associated with poor 28-day survival in patients hospitalized for AD of cirrhosis with or without ACLF. Regarding patients with AD or ACLF with IFI, HE, AKI, INR, PLT, and ACLF grading are independent risk factors affecting 28-day outcomes.

中文翻译：

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肝硬化急性失代偿中的侵袭性真菌感染：流行病学、28 天死亡率的预测因素和结果

摘要

慢性肝衰竭（ACLF）是一种严重的综合征，其特征是急性失代偿（AD）、器官衰竭和高短期死亡率。 AD或ACLF患者一旦出现侵袭性真菌感染（IFI）并发症，死亡率进一步上升。在这项研究中，共有 1636 名 2008 年 1 月至 2017 年 12 月期间在中国北京中国人民解放军总医院第五医学中心诊断的肝硬化 AD 患者入组。 1636例肝硬化AD患者中，191例并发IFI，并调查其流行病学特征。进行 Cox 比例风险回归分析影响 AD 或 ACLF 合并 IFI 28 天生存的因素。研究结果表明，肝硬化AD患者IFI发生率为13.5%；最常见的感染源是肺炎；最常见的真菌菌株是白色念珠菌，其次是烟曲霉。此外，IFI 与因肝硬化 AD 合并或不合并 ACLF 住院的患者 28 天生存率较差相关。对于具有 IFI 的 AD 或 ACLF 患者，HE、AKI、INR、PLT 和 ACLF 分级是影响 28 天结果的独立危险因素。