Establishment and validation of a prognostic model for hepatitis B virus‑related acute-on-chronic liver failure patients with bacterial infection

Abstract

Background Bacterial infection is one of the most frequent complications in acute-on-chronic liver failure (ACLF), which leads to high mortality. However, a specific prognostic model for ACLF patients with bacterial infection has not been well established. Aim To establish and validate a nomogram for predicting 30-day mortality of hepatitis B virus-related ACLF (HBV-ACLF) patients with bacterial infection. Methods A total of 513 ACLF patients for HBV reactivation were enrolled in the prospective cohort, and 224 patients with bacterial infection were for derivation. Independent predictors were identified using multivariate logistic model and then assembled into a nomogram to predict 30-day mortality. The performance of the nomogram was assessed based on its calibration, discrimination and clinical utility in a retrospective cohort of 192 HBV-ACLF patients with bacterial infection. Results Age, total bilirubin, lactate dehydrogenase, international normalized ratio and soluble interleukin-2 receptor were shown to be independent risk factors for 30-day mortality of HBV-ACLF patients with bacterial infection and the nomogram was constructed. The nomogram showed a good calibration and discrimination in the derivation cohort, with an area under the receiver operating characteristic curve (AUC) of 0.883. Application of the nomogram in the validation cohort also showed a good calibration and discrimination, with the AUC of 0.852. Decision curve analysis confirmed the clinical utility of the nomogram. ConclusionThe nomogram was established and validated for predicting 30-day mortality of HBV-ACLF patients with bacterial infection, which may facilitate optimal therapeutic strategies to improve the prognosis of these patients.

Granulocyte Colony-Stimulating Factor Accelerates the Recovery of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure by Promoting M2-Like Transition of Monocytes

“…and positive urine culture; or at least 2 of the above presentations and more than 10 leukocytes/μL in urine. (iv)bacteremia: positive blood culture ( 29 , 30 ).…”

Orchestrated regulation of immune inflammation with cell therapy in pediatric acute liver injury

“…In a CCL 4 -induced ALI mouse model, the effects of EVs released from hepatocytes and other non-parenchymal cells on hepatic macrophages were explored, indicating that EVs play a pivotal role in liver regeneration by depolarizing MoMF and inducing Kuffer cells to M2-type ( 58 , 59 ). Although M2-like macrophage response promotes injured liver repair and regeneration, the immune suppressive mediators released into the circulation can be harmful and lead to immune-compromised status, therefore increasing the susceptibility to infections, even immune paresis in sepsis in PALF ( 60 – 62 ). Therefore, immune evaluation for children with indeterminate, progressive hepatitis or indeterminate ALF should be carried out, including assessments for T cell activation, macrophage activation, NK cell function, and other serum biochemical markers ( 63 ).…”

A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients

“…Zhang Z and Rui et al reported that two predictive models (one named GIC including serum globulin, IL-6, and CRP; the other model including albumin, CRP, and glucose) can predict the bacterial infection development in HBV-ACLF patients 6 , 7 . Furthermore, some parameters, such as age, total bilirubin, lactate dehydrogenase, soluble IL-2 receptor, WBC count, etc., were also identified as independent predictors for mortality in ACLF patients with infection 8 , 9 . However, besides immune-inflammatory responses 10 , 11 , hypermetabolism and coagulation dysfunction lacking attention have already existed at a very early stage of infection 12 , 13 .…”