Abstract: Objective This paper aimed to investigate the clinical features and influencing factors of invasive fungal infections (IFI) in patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). Methods The clinical data of 130 patients with HBV-ACLF admitted in our hospital between January 2017 and January 2020 were collected and analyzed retrospectively. The incidence, location and species of IFI in patients with ACLF were documented. The multivariate Logistic regression analysis was applied analyze the risk factors for IFI in patients with ACLF. Results Out of the 130 patients with HBV-ACLF in our series, the incidence of IFI was 38.5%, and the common infection sites were in upper respiratory tract and lung infection in 24 cases(48.0%), gut infection in 14 cases(28.0%), urinary tract infection in 7 cases(14.0%), blood infection in 4 cases (8.0%) and peritoneal infection in 1 case(2.0%); the most common pathogenic bacteria was the Candida albicans in 26 cases(52.0%); the percentages of age older than 40 year and long-term administration of antibiotics in patients with IFI were significantly higher than in patients without (P<0.05), total serum bilirubin and prothrombin time were significantly higher or longer than, while serum albumin level was much lower than in patients without IFI(P<0.05); multivariate Logistic regression analysis showed that older than 40 year (OR=3.332), incredible hyperbilirubinemia (OR=4.525) and long-term intravenous administration of antibiotics(OR=1.576) were the independent risk factors for IFI in patients with ACLF(P<0.05). Conclusion The main sites of invasive fungal infection in patients with HBV-ACLF are upper respiratory tract and lung, and the main common pathogenic bacteria is Candida albicans. The peripheral blood white blood cell counts, serum bilirubin levels, and PT increase or elongated. The patients’ age older than 40 year, intravenous infusion of antibiotics longer than 4 weeks and excessive high serum bilirubin levels are the risk factors for invasive fungal infection in patients with HBV-ACLF. Therefore, targeted preventive measures should be taken to deal with them, which might reduce the complications and improve the prognosis.

Key words: Acute-on-chronic liver failure, Invasive fungal infection, Clinical feature, Risk factor