Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival. Patients 407 patients with ACLF and 235 patients with acute decompensation (AD). Results 152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%). Conclusion Bacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies.

中文翻译：

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急性加慢性肝衰竭中的细菌和真菌感染：患病率、特征和对预后的影响

细菌感染是急性慢性肝功能衰竭 (ACLF) 的常见诱因，该综合征也可能增加感染风险。该调查评估了导致 ACLF 并使 ACLF 复杂化的细菌和真菌感染的患病率和特征、后续细菌感染的预测因子以及细菌感染对生存的影响。患者 407 名 ACLF 患者和 235 名急性失代偿 (AD) 患者。结果 152 名患者（37%）在 ACLF 诊断时出现细菌感染；其余 255 名 ACLF 患者中有 46%（n=117）在随访期间（4 周）出现细菌感染。AD 患者的相应数字分别为 25% 和 18% (p<0.001)。严重感染（自发性细菌性腹膜炎、肺炎、严重败血症/休克、院内感染和多重耐药菌引起的感染）在 ACLF 患者中更为普遍。患有 ACLF 和细菌感染的患者（在诊断时或在随访期间）在诊断出该综合征时表现出更高级别的全身炎症，更差的临床病程（最终评估时 ACLF 2-3：47% 对 26%；p<0.001）与没有感染的 ACLF 患者相比，90 天的生存概率较低（49% 对 72.5%；p<0.001）。细菌感染与 ACLF-1 和 ACLF-2 患者的死亡率独立相关。9 名 ACLF 患者 (2%) 发生真菌感染，没有 AD 患者，主要发生在 ACLF 诊断后 (78%)，90 天死亡率高 (71%)。结论ACLF中细菌感染极为频繁。它们很严重，并伴有强烈的全身炎症，临床病程差，病死率高。ACLF 患者很容易在短期随访内发生细菌感染，并且可以从预防策略中受益。