{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:10:13Z","timestamp":1778735413355,"version":"3.51.4"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome characterized by acute hepatic decompensation in patients with chronic liver disease and is associated with a high short-term mortality rate. Pneumonia, hepatic encephalopathy (HE), and acute kidney injury (AKI) are among the most common and severe complications during hospitalization, yet data regarding their risk factors in hepatitis B virus\u2013related ACLF (HBV-ACLF) remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study consecutively enrolled 132 patients with HBV-ACLF. Demographic characteristics, laboratory parameters, and in-hospital complications were collected. Pneumonia, HE, and AKI were defined according to established guidelines. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors associated with each complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 132 patients with HBV-ACLF were included. Pneumonia occurred in 24 patients and was independently associated with older age (OR 1.055,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.012) and lower serum albumin levels (OR 0.915,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.047). HE developed in 30 patients and was independently associated with elevated serum ammonia (OR 2.403,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.047). AKI occurred in 23 patients and was independently associated with older age (OR 1.078,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.008) and higher baseline serum creatinine (OR 1.068,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.005).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pneumonia, HE, and AKI in HBV-ACLF are driven by distinct clinical and biochemical risk profiles. Readily available admission variables may facilitate early risk stratification and enable timely, complication-specific interventions, potentially improving clinical outcomes in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1804550","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:25:34Z","timestamp":1778732734000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for pneumonia, hepatic encephalopathy, and acute kidney injury in patients with hepatitis B virus\u2013related acute-on-chronic liver failure"],"prefix":"10.3389","volume":"13","author":[{"given":"Li","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Lanzhou Second People's Hospital","place":["Lanzhou, Gansu Province, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjuan","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Lanzhou Second People's Hospital","place":["Lanzhou, Gansu Province, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuefang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Lanzhou Second People's Hospital","place":["Lanzhou, Gansu Province, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiwen","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Lanzhou Second People's Hospital","place":["Lanzhou, Gansu Province, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Lanzhou Second People's Hospital","place":["Lanzhou, Gansu Province, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoli","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Lanzhou Second People's Hospital","place":["Lanzhou, Gansu Province, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e15733","DOI":"10.1111\/liv.15733","article-title":"Mechanisms and treatment approaches for ACLF","volume":"45","author":"Piano","year":"2025","journal-title":"Liver Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1136\/gutjnl-2023-330584","article-title":"Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers","volume":"73","author":"Trebicka","year":"2024","journal-title":"Gut"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1080\/17474124.2025.2456121","article-title":"AKI in ACLF: navigating the complex therapeutic puzzle","volume":"19","author":"Maiwall","year":"2025","journal-title":"Expert Rev Gastroent"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.jhep.2014.09.005","article-title":"Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure","volume":"62","author":"Romero-G\u00f3mez","year":"2015","journal-title":"J Hepatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1055\/s-0038-1657751","article-title":"Bacterial infections in acute-on-chronic liver failure","volume":"38","author":"Yang","year":"2018","journal-title":"Semin Liver 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Care"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12891-023-07123-0","article-title":"Risk factors for hospital-acquired pneumonia in hip fracture patients: a systematic review and meta-analysis","volume":"25","author":"Yao","year":"2024","journal-title":"BMC Musculoskel Dis"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"495","DOI":"10.2147\/CIA.S352736","article-title":"Relationship between preoperative hypoalbuminemia and postoperative pneumonia following geriatric hip fracture surgery: a propensity-score matched and conditional logistic regression analysis","volume":"17","author":"Tian","year":"2022","journal-title":"Clin Interv Aging"},{"key":"ref30","first-page":"57","article-title":"Hepatic encephalopathy: pathogenesis","volume":"25","author":"Bernardini","year":"1988","journal-title":"Arq Gastroenterol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"4456","DOI":"10.1038\/s41467-023-40081-8","article-title":"Effects 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