Pulmonary Infections in HBV-ACLF Patients Elevate Mortality Risk: Early Intervention Critical, Study Suggests

In their findings published in BMC Pulmonary Medicine, the researchers pointed out that certain risk factors, including invasive procedures and hepatic encephalopathy, increased the susceptibility of HBV-ACLF patients to pulmonary infections. Additionally, comorbidities like diabetes and elevated neutrophil counts were associated with a higher risk of mortality within 30 days. A predictive model incorporating these variables showed superior accuracy over traditional prognostic tools, with an area under the curve (AUC) of 0.832. This model emphasizes the importance of early risk assessment and timely intervention, which can significantly improve the prognosis of this vulnerable patient group.

Led by Liang Chen from the Department of Liver Disease at the Shanghai Public Health Clinical Center, Fudan University, Shanghai, China, the research team sought to identify the key risk factors for pulmonary infections in HBV-ACLF patients, assess how these infections impact patient outcomes, and develop a reliable prognostic model for early intervention.

To achieve these goals, the researchers retrospectively analyzed the clinical data of 393 HBV-ACLF patients. Using logistic regression, they identified risk factors associated with pulmonary infection. They evaluated the factors influencing prognosis in infected patients. They also developed a prognostic prediction model using the Nomogram method.

The key findings of the study include the following:

• Pulmonary Infections in HBV-ACLF Patients: Pulmonary infections were present in 38.7% of patients with HBV-ACLF.
• Impact on Mortality: Patients with pulmonary infections experienced significantly higher short-term mortality compared to those without infections (65.71% vs. 35.02%).
• Risk Factors for Pulmonary Infection: Independent risk factors for pulmonary infections included total bilirubin (TBIL), C-reactive protein (CRP), invasive procedures, peritoneal effusion, and hepatic encephalopathy.
• 30-day Mortality Risk Factors: Creatinine, international normalized ratio (INR), comorbid diabetes mellitus, neutrophil counts, and lymphocyte counts were identified as independent factors influencing 30-day mortality in patients with pulmonary infections.
• Predictive Model: The new predictive model, incorporating the identified risk factors, achieved an AUC of 0.832, outperforming traditional prognostic models like CTP, MELD, and MELD-Na.

The authors concluded, “Patients with HBV-ACLF are highly vulnerable to pulmonary infections, particularly fungal infections, which are linked to poorer outcomes. Given the diverse clinical presentations, timely identification of risk factors, careful evaluation of prognosis, and judicious use of antibiotics based on etiological findings are essential for guiding early and effective intervention.”

This study highlights the critical need for early identification and management of pulmonary infections in HBV-ACLF patients. By utilizing the new predictive model, healthcare providers can better assess risk, intervene promptly, and ultimately improve patient outcomes in this high-risk population.

Reference:

Wang, N., Zheng, Y., Tao, S. et al. Risk factors and prognosis of pulmonary infection in hepatitis B-related acute-on-chronic liver failure: a retrospective cohort study. BMC Pulm Med 25, 178 (2025). https://doi.org/10.1186/s12890-025-03628-7