The Relationship Between Liver Cirrhosis Complicated With Nosocomial Pneumonia And NK Cells And B Cells

Background:Cirrhosis is a common chronic progressive disease in clinical practice,belonging to chronic progressive liver disease.Infection is the main factor leading to death of patients with cirrhosis,which can aggravate the progression of liver disease and lead to liver decompensation.Liver function decline will cause the synthesis of immune active substances of patients,immune function decline,make patients easy to be complicated with other infections,aggravate the disease and even lead to death of patients.Because the liver function of patients with posthepatitis cirrhosis is seriously damaged,the immune defense performance of patients’ organs is reduced to a certain extent,which increases the incidence of nosocomial infection,especially nosocomial lung infection.Nosocomial pneumonia is one of the most common complications of liver cirrhosis mainly caused by bacterial infection.The main symptoms of nosocomial pneumonia are cough,sputum,fever and other systemic and respiratory reactions.Infection is a common complication and a common cause of death in patients with cirrhosis.Literature has shown that the fatality rate is much higher than that of other infections.The mortality rate is as high as 30% within 1 month after infection,and higher than 50% after 1 year.With the abuse or non-standard use of antibiotics,multi-drug-resistant bacterial infection has greatly increased and affected the prognosis of patients.Data show that multi-drug-resistant bacterial infection has become the primary cause of disease progression and death in patients with cirrhosis.Therefore,early detection of infection,correct diagnosis and active anti-infection treatment in patients with cirrhosis are important measures to save patients’ lives,improve prognosis and improve patients’ quality of life.Nosocomial pulmonary infection is one of the multiple complications with high mortality and morbidity.At present,there are few contents about cirrhosis complicated with nosocomial pulmonary infection,and there are no studies on the correlation between nk cells and B cells in cirrhosis complicated with nosocomial pneumonia.In order to help patients with posthepatitis cirrhosis to further clarify the clinical evidence of nosocomial pulmonary infection,In this study,the clinical characteristics and risk factors of nosocomial pulmonary infection in patients with posthepatitis cirrhosis were briefly described.Purpose: In this study,by analyzing the relationship between NK cells and B lymphocytes and nosocomial pneumonia(HAP)in patients with cirrhosis,the identification of nosocomial pulmonary infection in patients with cirrhosis and early assessment of the existence of infection are the key to prevent and reduce the incidence of infection.Analysis of NK cells,B cells and immune-related risk factors in patients with cirrhosis complicated with nosocomial pneumonia has certain clinical prediction value for understanding patients’ immune status and disease progression,and its influence on early prediction,diagnosis,treatment and prognosis of such diseases,so as to facilitate early screening,early intervention and early immunological support therapy in the future when such susceptible patients are encountered.Methods: This retrospective study included 64 patients with cirrhosis in our department from January 1,2022 to December 31,2022.The patients were divided into two groups according to whether they were complicated with lung infection.Group A included 30 patients with cirrhosis and nosocomial pneumonia.Group B consisted of 34 patients with cirrhosis without pulmonary infection.General clinical data were collected from all admitted patients,including age,sex,history of upper gastrointestinal bleeding within 30 days,death,etc.Meanwhile,neutrophil ratio,neutrophil percentage,and C were measured at admission Reactive protein,procalcitonin,blood ammonia,IFN-a,IFN-γ,IL-10,IL-12P70,IL-17,IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,TNF-a,blood ammonia,PT%,APTT(S),PT(S),percentage of NK cells,absolute value of NK cells,B cell percentage %,B cell absolute value,chest CT and other indicators.The relevant data between the two groups were compared,and the different indicators were incorporated into the binary Logistics regression model to analyze the risk factors of cirrhosis complicated with nosocomial pulmonary infection.Compared with the two groups of samples,the difference was significant(P<0.05).The ROC curve was used in the diagnostic test to evaluate the predictive value of related variables in cirrhosis patients complicated with nosocomial pneumonia(HAP).Results: 1.A total of 64 patients were included in this study,including 30 patients with cirrhosis complicated with nosocomial pneumonia and 34 patients with cirrhosis.A total of 64 patients were included in this study,including 30 patients with cirrhosis complicated with nosocomial pneumonia and 34 patients with cirrhosis.By comparing the clinical data of the two groups,the mean age of patients with cirrhosis combined with nosocomial pneumonia was 54.10±9.77 years old,the proportion of males was 18(60%),the proportion of females was 12(40%),and the proportion of patients with cirrhosis after viral hepatitis B was: 15(50%),16(53.3%)of patients with hepatitis C cirrhosis,2(6.7%)of patients with autoimmune cirrhosis,and 2(6.7%)of patients with cirrhosis from other causes: 2(6.7%),the mean age of patients with cirrhosis without pulmonary infection was 52.44 ± 12.13 years old,the proportion of males was 22(64.7%),the proportion of females was 12(35.3%),the proportion of patients with cirrhosis after viral hepatitis B was 10(29.4%),the proportion of patients with autoimmune cirrhosis was 2(5.9%),and other factors Because the proportion of cirrhosis was 0(0%),P value was less than 0.05 between the two groups,and there was no significant statistical difference.The proportion of patients with cirrhosis complicated with nosocomial pneumonia within 30 days was16(53.3%),the proportion of patients with 30-day mortality was 3(10%),and the proportion of patients with pleural effusion was 6(20%).In the cirrhosis group without pulmonary infection,the proportion of patients with upper gastrointestinal bleeding within 30 days was 7(20.6%),the proportion of patients with 30-day mortality was 0(0%),and the proportion of patients with pleural effusion was: 1(2.9%).The proportion of patients with HAP in cirrhotic patients with upper gastrointestinal bleeding,mortality and pleural effusion within 30 days was significantly higher than that in cirrhotic patients without pulmonary infection,all P values < 0.05,with statistical significance.2.IL-6 values were 24.36(7.87-52.43),IL-10 values were 4.57(2.77-11.89)and TNF-α values were 2.15(1.30-4.35)in patients with cirrhosis and HAP.IL-6 values were 6.04(3.08-12.30),IL-10 values were 2.35(1.90-7.53)and TNF-α values were5.14(2.13-12.07)in cirrhosis group without pulmonary infection.There were significant differences in IL-6,IL-10 and TNF-α between HAP group and non-pulmonary infection group(P < 0.05),and the values of IL-6 and IL-10 in HAP group were significantly higher than those in non-pulmonary infection group.The value of TNF-α in patients with cirrhosis and HAP was significantly lower than that in patients with cirrhosis and non-pulmonary infection.There were no significant differences in other indexes of IFN-a,IFN-γ,IL-12P70,IL-17,IL-1β,IL-2,IL-4,IL-5,IL-6 and IL-8(P > 0.05).3.CRP(mg/L)value of 18.04(10.28-18.04),PCT(ng/ml)value of 0.34(0.10-0.61),PT(S)value of 17.95±4.06 in cirrhotic patients with HAP;Leukocyte(X10^9/L):6.33±4.21,neutrophil count: 4.55(2.91-8.66),neutrophil percentage: 60.61±9.79,NK cell absolute value(/u L): 88.14(57.58-135.78),B cell absolute value(/u L):108.00(40.12-278.50);CRP(mg/L)value: 0.67(0.18-3.39),PCT(ng/ml)value: 0.07(0.03-0.12),PT(S)value: 16.11 ± 2.63;Leukocyte(X10^9/L): 4.11 ± 2.00,neutrophil count: 2.01(1.52-3.38),neutrophil percentage: 70.91 ± 13.10,NK cell absolute value(/u L): 44.25(23.12-70.72),B cell absolute value(/u L): 179.50(140.00-247.75).There were significant differences in CRP,PCT,PT,leukocyte,neutrophil count,neutrophil percentage,absolute value of NK cells and absolute value of B cells between the cirrhosis combined with HAP group and the cirrhosis non-pulmonary infection group(P < 0.05).The values of CRP,PCT,PT,leukocyte,neutrophil count and neutrophil percentage in the cirrhosis group were significantly higher than those in the cirrhosis group without pulmonary infection.The absolute values of NK cells and B cells in the cirrhotic patients with HAP were significantly lower than those in the cirrhotic patients without pulmonary infection.4.Multivariate Logistic regression analysis showed that gastrointestinal bleeding within 30 days(OR = 13.2,95%CI :1.14-49.30,P = 0.039),neutrophil count(OR =2.14,95%CI: 1.05-4.34,P = 0.036),absolute value of B cells(OR = 1.01,95% CI:1.01-1.02,P = 0.038),CRP(OR = 1.69,95% CI: 1.15-2.50,P = 0.008),absolute value of NK cells(OR = 1.05,95%CI: 1.01-1.10,P = 0.032),which were independent risk indicators of cirrhosis complicated with HAP.5.The sensitivity,specificity and AUC of absolute value of NK cells were 0.82,0.7,0.78(0.67-0.90),and the absolute value of NK cells was lower than 55.30/u L,indicating the possibility of lung infection.The absolute values of B cells were 0.76 sensitivity,0.63 specificity,and 0.68 AUC(95%CI).The absolute values of B cells were lower than 134/u L,suggesting low diagnostic value of association with pulmonary infection.Conclusions: 1.CRP,elevated neutrophil count and upper gastrointestinal bleeding within 30 days were independent risk factors.2.Decrease of NK cells and B cells is an independent risk factor for cirrhosis complicated with nosocomial pneumonia.3.The absolute value of NK cells was less than 55.30/u L,indicating the possibility of moderate diagnosis and prediction of lung infection.The absolute value of B cells was less than 134/u L,suggesting low diagnostic value for lung infection.