Abstract: Objective The aim of this study was to analyze influencing factors of patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF) complicated by hospital-acquired pneumonia (HAP). Methods A total of 101 patients with HBV-ACLF and HAP were encountered in our hospital between January 2018 and December 2022, and all received comprehensive internal medical and liver-supporting treatment. Sputum culture and bacteria characterization were routinely performed. Univariate and multivariate Logistic regression analysis was applied to analyze independent risk factors influencing prognosis. Results Of 101 patients with HBV-ACLF and HAP, sputum obtained positive results in 76 cases (75.3%), and out of them, Gram positive pathogenic bacteria strain was found in 30 cases (39.5%), Gram negative in 11 cases (14.5%) and fungus in 35 cases (46.1%); 50 patients (49.5%) died and 51 patients (50.5%) survived during (44.7±24.4)day hospital stay; ages, plasma lactate level, model of end-stage liver disease score, percentages of concomitant spontaneous bacterial peritonitis (SBP) and gastrointestinal bleeding (GIB) in dead patients were(57.3±12.1)yr, (2.7±2.1)mmol/L, (27.5±6.9)point, 66.0% and 42.0%, all much higher than [(50±12.8)yr, (1.6±0.8)mmol/L, (22.5±7.3)point, 31.4% and 5.9%, respectively, P＜0.05] in survivals; multivariate Logistic regression analysis showed that age (OR=1.054, 95%CI:1.005-1.110), plasma lactate level (OR=2.339, 95%CI:1.255-5.031), concomitant SBP(OR=6.784, 95%CI:2.139-25.206) and GIB (OR=18.504, 95%CI:3.973-122.636) were the independent risk factors impacting prognosis (P＜0.05). Conclusion The patients with HBV-ACLF and HAP have a poor prognosis, clinicians should pay more attention to those who are elderly and with more than one complications, and take an appropriate measures in time to improve the outcomes.

Key words: Acute-on-chronic liver failure, Hospital-acquired pneumonia, Pathogens, Prognosis, Impacting factors