Search

Objective·To explore the influencing factors of bacterial infection in decompensated stage of hepatitis C cirrhosis, and establish a risk prediction model of nomogram.Methods·A total of 574 patients with decompensated hepatitis C cirrhosis were retrospectively collected from The Third People′s Hospital of Kunming between January 2020 and December 2021, and divided into non-infected and infected groups according to whether bacterial infection occurred. The general information, complications, and laboratory indicators were collected. The variables were screened by univariate analysis, and least absolute shrinkage and selection operator (LASSO) regression, and the nomogram model were constructed and verified by multivariate Logistic regression analysis of influencing factors. The decision curve and clinical impact curve (CIC) were used to evaluate the clinical application value of the model.Results·Bacterial infections occurred in 28.4% (163/574) of the patients, with a total of 191 sites, mainly including spontaneous bacterial peritonitis (86/191) and pulmonary bacterial infections (79/191). Totally 78 strains of pathogens were isolated and cultured, mainly including Klebsiella pneumoniae (15/78) and Escherichia coli (15/78). Multivariate Logistic regression analysis showed that age ≥60 years [odds ratio (OR)=2.054, 95% confidence interval (CI) 1.104‒3.822, P=0.023], female (OR=1.701, 95%CI 1.112‒2.602, P=0.014), ascites (OR=2.386, 95%CI 1.601‒3.557, P=0.000), history of invasive procedures in the last two weeks (OR=2.605, 95%CI 1.368‒4.960, P=0.004), and hospitalization time≥2 weeks (OR=1.629, 95%CI 1.098‒2.416, P=0.015) were independent risk factors for bacterial infection in decompensated hepatitis C cirrhosis patients, while infusing human serum albumin (OR=0.324, 95%CI 0.194‒0.542, P=0.000) and high level of total cholesterol (OR=0.675, 95%CI 0.549‒0.830, P=0.000) were protective factors. The nomogram model was constructed with the above seven influencing factors. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) was 0.736 and the sensitivity was 80.4%; and the specificity was 65.1%. Hosmer-lemeshow test showed that the model had a good degree of fit (χ2=9.030, P=0.340). The bootstrap method was used for internal repeated sampling for 1 000 times, the average absolute error was 0.010, the calibration curve and the ideal curve were basically fitted, and the predicted values were in good agreement with the actual values. The decision curve showed that the nomogram model had certain clinical practicability in the high risk threshold range (0.040‒0.715). CIC showed that the nomogram model can be used to forecast the high-risk population in different levels.Conclusion·The nomogram risk prediction model constructed in this study has good predictability, consistency and clinical practicability, and can provide evidence for clinicians to preliminary judge the risk of bacterial infection in patients with decompensated hepatitis C cirrhosis.

Objective: To prospectively observe the long-term antiviral efficacy and safety of telbivudine (LDT) administered as a monotherapy and as a combination therapy with adefovir dipivoxil (ADV) in patients diagnosed with chronic hepatitis B (CHB) and positivity for hepatitis B e antigen (HBeAg)., Methods: A total of 140 patients with HBeAg-positive CHB were randomly divided into treatment groups for LDT monotherapy (n = 75; 600 mg orally, once daily) and LDT+ADV combination therapy (n = 65; LDT 600 mg plus ADV 10 mg orally, once daily). The shortest treatment course was 96 weeks and the longest was 240 weeks. At treatment weeks 12, 24, 48?, 96, 144, 192, and 240 patients were tested for hepatitis B virus (HBV) DNA, HBeAg seroconversion and ALT normalization time; in addition, the incidence and type of adverse drug reactions were recorded. Data were statistically analyzed to determine the significance of differences observed between groups., Results: The rate of patients experiencing more than or equal to 2 log HBV DNA reduction was higher in the LDT + ADV group (92.3%(60/65) vs. LDT: 86.7%(65/75), X2 = 1.58). The HBV DNA negative rates of the LDT and LDT + ADV groups were 62.7% and 61.5% (X2 = 0.01) at week 24, 76.0% and 81.5% (X2 = 0.63) at week 48, 80.0% and 89.2% (X2 = 2.2) at week 96, 78.3% and 93.3% (X2 = 3.24) at week 144, 83.7% and 91.7% (X2 = 0.47) at week 192, and 93.3% and 88.9% at week 240 (comparison between two groups for each point P more than 0.05); both groups showed higher early and rapid sustained HBV DNA negative rates. For the HBeAg seroconversion, the rates of the LDT and LDT + ADV groups were 17.3% and 23.1% (X2 = 0.71) at week 24, 29.3% and 30.8% (X2 = 0.03) at week 48, 42.7% and 40.0% (X2 = 0.10) at week 96, 55.0% and 43.3% (X2 = 1.08) at week 144, 55.8% and 66.7% (X2 = 0.45) at week 192, and 63.3% and 66.7% at week 240; however, pairwise comparison showed no statistically significant differences between the groups (P more than 0.05). Similarly, there was no significant difference between the two groups in incidence of resistance at week 48 (4.0% and 1.5%), week 96 (5.3% and 3.1%), week 144 (10.0% and 3.3%, X2 = 1.23), week 192 (11.6% and 8.3%), and week 240 (13.3% and 11.1%) (all P more than 0.05). Three patients experienced muscle soreness (LDT, n = 2; LDT + ADV, n = 1) and two patients experienced increased creatine phosphokinase (LDT, n = 1; LDT + ADV, n = 1); all side effects resolved spontaneously or with symptom-appropriate treatment., Conclusion: The long-term efficacy of LDT as a monotherapy or as a combination therapy with ADV was similar and the two different treatment approaches were associated with similar rates of resistance. The long-term safety was good for both treatment approaches.