Early diagnosis of bacterial and fungal infection in chronic cholestatic hepatitis B.
OBJECTIVE
To investigate the early diagnostic methods of bacterial and fungal infection in patients with chronic cholestatic hepatitis B.


METHODS
One hundred and one adult in-patients with chronic hepatitis B were studied and divided into 3 groups: direct bilirubin (DBil)/total bilirubin (TBil) > or = 0.5, without bacterial and fungal infection (group A, n=38); DBil/TBil <0.5, without bacterial and fungal infection (group B, n=23); DBil/TBil> or = 0.5, with bacterial or fungal infection (group C, n=40). The serum biochemical index and pulse rate were analyzed.


RESULTS
Level of TBil, DBil, alkaline phosphatase (ALP) and DBil/ALP in group A increased compared with that in group B. The level of ALP in group C decreased compared with that in group A, whereas the level of TBil, DBil and DBil/ALP increased (ALP: 156+/-43, 199+/-68, respectively, P<0.05; TBil: 370+/-227, 220+/-206, respectively, P<0.01; DBil: 214+/-143, 146+/-136, respectively, P<0.01; DBil/ALP: 1.65+/-1.05, 0.78+/-0.70, respectively, P<0.001). The level of DBil and infection affected DBil/ALP. Independent of the effect of DBil, infection caused DBil/ALP to rise (P<0.05). The pulse rate in group A decreased compared with that in group B (63.7+/-6.4, 77.7+/-11.4, respectively, P<0.001), and the pulse rate in group C increased compared with that in group A (81.2+/-12.2, 63.7+/-6.4, respectively, P<0.001). The equation (infection=0.218 pusle rate +1.064 DBil/ALP -16.361), with total accuracy of 85.5%, was obtained from stepwise logistic regression. Pulse rate (> or =80/min) and DBil/ALP (> or =1.0) were used to screen infection. The sensitivity was 62.5% and 64.7% respectively, and the specificity was 100% and 82.8% respectively.


CONCLUSIONS
Bacterial and fungal infection deteriorate jaundice and increase pulse rate, decrease serum ALP and increase DBil/ALP. Pulse rate, DBil/ALP and the equation (infection=0.218 pusle rate+1.064 DBil/ALP-16.361) are helpful to early diagnosis of bacterial and fungal infection in patients with chronic cholestatic hepatitis B.
Wu
Xiong-Zhi
XZ
Infectious Disease Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. ilwxz@163.com
Chen
Dan
D
Zhao
Lian-San
LS
Yu
Xiao-Hui
XH
Wei
Mei
M
Zhao
Yan
Y
Fang
Qing
Q
Xu
Qian
Q
D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis*; D002780:Cholestasis, Intrahepatic / Q000821:virology*; D042241:Early Diagnosis; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D009181:Mycoses / Q000150:complications* / Q000175:diagnosis*