| Background and AimsBecause of the immune function disorder patients suffering from liver failure are easier to be infected.A large number of research about hepatic failure with bacterial infection have been accomplished,however there are few studies about liver failure with invasive fungal disease(IFD).This study was designed to analyze the infection situation,clinical characteristics,efficacy of antifungal therapy and risk factors of poor prognosis of acute liver failure(ALF),subacute liver failure(SALF)and acute-on-chronic liver failure(ACLF)which all were combined with IFD,in order to provide clues about the diagnosis,therapy,prevention of these diseases,improve the prognosis and lowering the death rate.Methods142 patients suffering from ALF,SALF and ACLF with IFD were selected into our study,which were hospitalized in the first affiliated hospital of Zhejiang University School of Medicine from September 2013 to September 2016.Basic information,clinical manifestation,laboratory examination,image examination,antifungal therapy,and prognosis of these patients were collected and statistically analyzed by SPSS 22.0,and lastly searched the risk factors of poor prognosis by Cox regression analysis.ResultsTotally 142 patients were researched in this study,including 106 men(74.65%)and 36 women(25.35%),with an average age of(51.95±12.52)years.The diagnosis consisted of 30 ALF/SALF resulting from drug and 112 ACLF infected by HBV,10 patients were proven to suffered with IFD,46 patients were probably diagnosed with IFD and the rest were all diagnosed with IFD possible.Candida albicans was the most common pathogen bringing about IFD,followed by aspergillus.54.93%of patients were showed with pulmonary fungal infection which occupied half more of Infection site,followed by abdominal cavity.The most common clinical manifestation was fever with a percentage of 88.03%and temperature fluctuated between 38 ? and 39.5?.There were other clinical manifestations including cough,expectoration,chest distress and so on,and that blood-stained sputum were seen in 6 patients with IPA.By comparing the laboratory information before and after IFD,hs-CRP(P = 0.000),WBC(P = 0.020),TBIL(P = 0.000),Scr(P = 0.043),BUN(P = 0.000),INR(P = 0.016),APTT(P = 0.000)and PT(P = 0.047)were found to be higher after IFD,reaching statistical significance and HGB(P = 0.000),PLT(P = 0.000),ALT(P = 0.000),AST(P=0.000),STP(P = 0.000)and GLO(P = 0.000)were all lower after IFD with a significant differences.56 of all patients were treated effectively with a 40%effective rate.40 patients were treated with fluconazole and 19 patients(47.5%)were effective;37 patients were suggested to be given voriconazole and 14(37.8%)patients were effective;Micafungin were used to treat 63 patients and 23(36.51%)patients acquired an effective result,and there were no significant differences among three drugs(P=0.392,0.269,0.894).2 patients died of respiratory failure resulting from refusing to accept antifungal therapy.In patients suffered from ALF/SALF and ACLF with IPA,the effective rate of voriconazole was 37.93%and micafungin was 16.67%.The survival rate was found to be higher in voriconazole group compared to micafungin group(P=0.027).The age>65years(P=0.005),no antifungal therapy(P=0.020),higher TBIL(?405umol/L)(P = 0.000),lower PLT(<51*10^9/L)(P = 0.03)were founded to be the risk factors of death of ALF/SALF and ACLF with IFD by Cox regression analysis.ConclusionsFungal infection was more easily to be detected in patients with ALF/SALF and ACLF because of some risk factors,in which the Candida was the most common,followed by aspergillus.It was difficult to be diagnosed in early stage on account of the lack of specificity about clinical manifestation.Appropriate antifungal therapy could improve prognosis and lower the death rate after making a proven diagnosis of IFD.Older age,no antifungal therapy,higher TBIL,lower PLT were related to the poor prognosis and leaded to a high risk of short-term death in patients suffered from ALF/SALF and ACLF with IFD. |
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