title: Early diagnosis of bacterial and fungal infection in chronic cholestatic hepatitis B.
abstract: 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.
authors.affiliation: Infectious Disease Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. ilwxz@163.com
authors.forename: Xiong-Zhi
authors.initials: XZ
authors.lastname: Wu
authors.forename: Dan
authors.initials: D
authors.lastname: Chen
authors.forename: Lian-San
authors.initials: LS
authors.lastname: Zhao
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Yu
authors.forename: Mei
authors.initials: M
authors.lastname: Wei
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Qing
authors.initials: Q
authors.lastname: Fang
authors.forename: Qian
authors.initials: Q
authors.lastname: Xu
mesh_terms: 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*