Risk factors for pneumonia, hepatic encephalopathy, and acute kidney injury in patients with hepatitis B virus–related acute-on-chronic liver failure

Background 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–related ACLF (HBV-ACLF) remain limited. Methods 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. Results 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, p = 0.012) and lower serum albumin levels (OR 0.915, p = 0.047). HE developed in 30 patients and was independently associated with elevated serum ammonia (OR 2.403, p = 0.047). AKI occurred in 23 patients and was independently associated with older age (OR 1.078, p = 0.008) and higher baseline serum creatinine (OR 1.068, p = 0.005). Conclusion 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.