Objective To investigate the clinical features and risk factors for patients with liver failure complicated by invasive pulmonary aspergillosis( IPA),and to provide a reference for clinical diagnosis and treatment. Methods The clinical data of 477 patients with liver failure who were diagnosed and treated in Henan Provincial People's Hospital from January 2010 to December 2014 were collected,and the clinical features,laboratory markers,and results of imaging examinations of patients with IPA were retrospectively analyzed. Another 49 patients with liver failure who were hospitalized within the same period,had similar ages,and were not complicated by pulmonary infection were randomly selected as controls. The independent samples t- test was used for comparison of continuous data between groups,the chi-square test or Fisher's exact test were used for comparison of categorical data between groups,and multivariate logistic regression analysis was performed to analyze the risk factors for liver failure complicated by IPA. Results Among the 447 patients with liver failure,43( 9. 6%) were complicated by IPA. Age( P = 0. 023),hepatic encephalopathy( P = 0. 021),long- term use of broad- spectrum antibiotics( P = 0.007),use of hormone( P = 0. 016),and deep venous catheterization( P < 0. 001) were independent risk factors for the development of IPA. Clinical manifestations of liver failure patients with IPA lacked specificity. Lung CT scan showed multiple nodules,masses,and wedge- shaped consolidation near the pleura in both lungs,but typical halo sign and air crescent sign were rarely seen. Among the 35 patients who received antifungal therapy,30 were improved or cured,3 died of digestive tract bleeding,2 clied of plumonary infection,and all the other patients who did not receive therapy also died. Conclusion Patients with liver failure have various risk factors for the development of IPA,and the clinical manifestations are not typical,with high incidence and fatality rates. Early detection and treatment is the key to improving survival rates.
[1]ZICKER M,COLOMBO AL,FERRAZ-NETO BH,et al.Epidemiology of fungal infections in liver transplant recipients:a sixyear study of a large Brazilian liver transplantation centre[J].Mem Inst Oswaldo Cruz,2011,106(3):339-345.
|
[2] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,CMA;Severe Liver Diseases and Artificial Liver Group,Chinese Society of Hepatology,CMA.Guideline for diagnosis and treatment of liver failure(2012 version)[J].Chin J Clin Infect Dis,2012,5(6):321-327.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝治疗组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华临床感染病杂志,2012,5(6):321-327.
|
[3] Chinese Invasive Fungal Infections Cooperative Group.Diagnostic criteria and therapeutic principle of invasive fungal disease in patients with blood diseases/malignant tumors(4th revised edition)[J].Chin J Intern Med,2013,52(8):704-709.(in Chinese)中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第四次修订版)[J].中华内科杂志,2013,52(8):704-709.
|
[4]MAERTENS J,MARCHETTI O,HERBRECHT R,et al.European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients:summary of the ECIL 3---2009 update[J].Bone Marrow Transplant,2011,46(5):709-718.
|
[5]SHI Y.Update of diagnosis and treatment of invasive pulmonary fungal diseases[J].Chin J Tuberc Respir Dis,2011,34(2):83-85.(in Chinese)施毅.侵袭性肺真菌病诊治的再认识[J].中华结核和呼吸杂志,2011,34(2):83-85.
|
[6]BOFF C,ZOPPAS BC,AQUINO VR,et al.The indoor air as a potential determinant of the frequency of invasive aspergillosis in the intensive care[J].Mycoses,2013,56(5):527-531.
|
[7]PELEZ T,MUOZ P,GUINEA J,et al.Outbreak of invasive aspergillosis after major heart surgery caused by spores in the air of the intensive care unit[J].Clin Infect Dis,2012,54(3):e24-e31.
|
[8]GANGNEUX JP,ADJIDCC,BERNARD L,et al.Quantitative assessment of fungal risk in the case of construction works in healthcare establishments:proposed indicators for the determination of the impact of management precautions on the risk of fungal infection[J].J Mycol Med,2012,22(1):64-71.
|
[9]FOURNEL I,SAUTOUR M,LAFON I,et al.Airborne aspergillus contamination during hospital construction works:efficacy of protective measures[J].Am J Infect Control,2010,38(3):189-194.
|
[10]KPELI E,ULUBAY G,BAYRAM AKKURT S,et al.Invasive pulmonary aspergillosis in heart transplant recipients[J].Exp Clin Transplant,2015,13(Suppl 1):352-355.
|
[11]NAGAO M,FUJIMOTO Y,YAMAMOTO M,et al.Epidemiology of invasive fungal infections after liver transplantation and the risk factors of late-onset invasive aspergillosis[J].J Infect Chemother,2016,22(2):84-89.
|
[12]CHEN J,YANG Q,HUANG J,et al.Risk factors for invasive pulmonary aspergillosis and hospital mortality in acute-on-chronic liver failure patients:a retrospective-cohort study[J].Int J Med Sci,2013,10(12):1625-1631.
|
[13]WU Z,LING Z,SHAO F,et al.Invasive pulmonary aspergillosis in patients with acute-on-chronic liver failure[J].J Int Med Res,2012,40(5):1958-1965.
|
[1] | Siqin LIU, Xiaomei WANG, Xia LI, Luwen LIANG, Ke WANG, Rui WANG. Covert hepatic encephalopathy in liver cirrhosis: Risk factors and prognosis[J]. Journal of Clinical Hepatology, 2022, 38(2): 359-364. doi: 10.3969/j.issn.1001-5256.2022.02.020 |
[2] | Cheng ZHOU, Ran JIA, Jingjing WEI, Chenlu ZHAO, Dongfang SHANG, Wenxia ZHAO. Risk factors for cognitive impairment associated with nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2022, 38(11): 2592-2595. doi: 10.3969/j.issn.1001-5256.2022.11.031 |
[3] | Yao ChengZi, Liu ZiZhen, Feng Gong, He Na, Mi Man. Risk factors for childhood nonalcoholic fatty liver disease and related prevention and management strategies[J]. Journal of Clinical Hepatology, 2020, 36(7): 1623-1626. doi: 10.3969/j.issn.1001-5256.2020.07.038 |
[4] | Wang CaiBin, Su Yang. Risk factors for posthepatectomy liver failure and related prevention and treatment methods[J]. Journal of Clinical Hepatology, 2020, 36(9): 2119-2124. doi: 10.3969/j.issn.1001-5256.2020.09.048 |
[5] | Yao ChengZi, Feng Gong, Yu WenSi, Du Huan, Mi Man. Risk factors for the development and progression of nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2020, 36(2): 433-436. doi: 10.3969/j.issn.1001-5256.2020.02.044 |
[6] | Feng Gong, He Na, Mi Man, Li XuePing, Liu ManLing, Fan LiPing, Niu ChunYan. Risk factors for the coexistence of inflammatory bowel disease and nonalcoholic fatty liver disease: A Meta-analysis[J]. Journal of Clinical Hepatology, 2019, 35(4): 835-839. doi: 10.3969/j.issn.1001-5256.2019.04.025 |
[7] | Huang ZhiPeng, Jiang JianJia, Huang ZiCheng, Guo GuiYuan, Zhou APei, Liu XiaoQiang. Risk factors of nonalcoholic fatty liver disease with a normal visceral adipose tissue area[J]. Journal of Clinical Hepatology, 2019, 35(5): 1061-1064. doi: 10.3969/j.issn.1001-5256.2019.05.025 |
[8] | Liu HongJin, Bao ChunMei, Bai WenLin, Li YinYin, Rong GuangHua, Lu YinYing, Chen Yan, Liu Ze, Cheng JiaMin, Ceng Zhen. Risk factors for infectious complications in primary liver cancer[J]. Journal of Clinical Hepatology, 2018, 34(5): 1033-1037. doi: 10.3969/j.issn.1001-5256.2018.05.021 |
[9] | Li Ying, Zhan Jing, Wang ZhongFeng. Prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2017, 33(3): 497-501. doi: 10.3969/j.issn.1001-5256.2017.03.020 |
[10] | Wang FengJiao, Liu MingJiang, Wu RuiHong, Niu JunQi. A multivariate logistic regression analysis of short-term prognosis of patients with hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2017, 33(4): 711-714. doi: 10.3969/j.issn.1001-5256.2017.04.022 |
[11] | Liu ZhengFang, Huang Wei, Li Qin. A risk factors analysis of acute-on-chronic liver failure complicated by spontaneous bacterial peritonitis[J]. Journal of Clinical Hepatology, 2017, 33(4): 719-722. doi: 10.3969/j.issn.1001-5256.2017.04.024 |
[12] | Shi XinXing, Zhang YanQiong, Zhu Peng, Yan GuoHua, Zhang ZhangJiang, Wang YuMing. Prognostic risk factors in patients with hepatitis B virus- related acute- on- chronic liver failure[J]. Journal of Clinical Hepatology, 2016, 32(4): 700-705. doi: 10.3969/j.issn.1001-5256.2016.04.018 |
[13] | Chen BiHua, Zhang Wei, Wu Pei, Huang Ying. Research advances in risk factors for primary biliary cirrhosis[J]. Journal of Clinical Hepatology, 2015, 31(12): 2088-2092. doi: 10.3969/j.issn.1001-5256.2015.12.024 |
[14] | Yin TianSheng, Yi YaYang, Mao XiXian, Li DeWei. Meta-analysis of risk factors for posthepatectomy liver failure in patients with hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2014, 30(10): 1009-1014. doi: 10.3969/j.issn.1001-5256.2014.10.009 |
[15] | Chen YongFang, Wu ZhanJun. Pathogenesis and risk factors of cholesterol gallstones in patients with non- alcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2013, 29(12): 952-955. doi: 10.3969/j.issn.1001-5256.2013.12.021 |
[16] | Wu XiaoQing, Wan Hong. Causes of liver failure and impact analysis of prognostic risk factors[J]. Journal of Clinical Hepatology, 2013, 29(4): 294-296+304. |
[17] | Liu HongHong, Fu JunLiang, Fu BaoYun, Zhang Zheng, Xu RuoNan, Luo ShengQiang, Shi Ming, Li YongGang, Wang FuSheng. The pathogenesis and risk factors related to prognosis of primary biliary cirrhosis[J]. Journal of Clinical Hepatology, 2012, 28(2): 153-155. |
[18] | Zhang WenHua, Jia WenLing, Zhou ZiYing, Tang HaiTao, Wang FengMei. Investigation on the method and safety of the non-heparinized plasma exchange therapy in treating patients with hepatic failure[J]. Journal of Clinical Hepatology, 2012, 28(1): 50-52. |
[19] | Zhang YiNing, Du HongWei, Liu YanJun, Wang ChaoXia. The diagnosis and risk factors for evaluation of nonalcoholic fatty liver disease in children and adolescents[J]. Journal of Clinical Hepatology, 2011, 27(7): 690-693. |