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Impact of infection in hospitalized cirrhotic patients in a university hospital

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DOI: 10.4236/ojgas.2012.23026    3,843 Downloads   6,010 Views   Citations

ABSTRACT

Background: Infection increases the morbidity and mortality in liver cirrhosis patients. The aim of this study was to investigate the impact of infection related to survival and risk factors for death in adult patients with liver cirrhosis in a university hospital. Methods: In a retrospective cohort study of Brazilian hospitalized cirrhotic patients, medical records data were analysed, and all patients who have had one or more confirmed bacterial infection during admission were se-ected for the study. Also, some data as biochemical investigation, Child score, MELD estimation, and evolution and death event were included. Statistical analysis: chi-square, Fisher and Mann-Whitney tests were used. Uni and multivariate analysis were performed, according to Cox regression model. The significant statistical level was p < 0.05. Results: In a total of 1.221 medical records of hospitalized cirrhotic patients, 107 of them presented the diagnoses of infection. Evolution for death occurred in 29% of patients. The most common infections were spontaneous bacterial peritonitis (32.7%), urinary tract infection (31.8%) and pneumonia (15.9%). Spontaneous bacterial peritonitis (p < 0.027), ascites (p < 0.024), upper gastrointestinal bleeding (p < 0.039) were related with death outcome as well as MELD (p < 0.004), increased serum creatinine (p < 0.021), and low serum sodium (p < 0.010). Patients who had serum sodium <130 mEq/L, upper gastrointestinal bleeding episodes and serum creatinine >2.5 mg/dl had increased the risk of death of 4.1, 3.2 and 3.2, respectively. Conclusion: Bacterial infections in hospitalized cirrhotic patients deserve special care, mainly spontaneous bacterial peritonitis, and also patients whose hiponatremia, upper gastrointestinal bleeding, high levels of cre-atinine and MELD high score are found.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Ferreira, T. , Sevá-Pereira, T. , Almeida, J. , Fioravante, M. , Yamanaka, A. and Soares, E. (2012) Impact of infection in hospitalized cirrhotic patients in a university hospital. Open Journal of Gastroenterology, 2, 124-130. doi: 10.4236/ojgas.2012.23026.

References

[1] Garcia-Tsao, G., (2001) Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology, 120, 726-748. doi:10.1053/gast.2001.22580
[2] Tandon, P. and Garcia-Tsao, G. (2008) Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Seminars in Liver Disease, 28, 26-42. doi:10.1055/s-2008-1040319
[3] Merli, M., et al. (2010) Cirrhotic patients are at risk for health care-associated bacterial infections. Clinical Gastroenterology and Hepatology, 8, 979-985. doi:10.1016/j.cgh.2010.06.024
[4] Navasa, M., et al. (1998) Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: Relationship with the development of renal impairment and mortality. Hepatology, 27, 1227-1232. doi:10.1002/hep.510270507
[5] Caly, W.R. and Strauss, E., (1993) A prospective study of bacterial infections in patients with cirrhosis. Journal of Hepatology, 18, 353-358. doi:10.1016/S0168-8278(05)80280-6
[6] Bleichner, G., et al. (1986) Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage. British Journal of Surgery, 73, 724-76. doi:10.1002/bjs.1800730916
[7] Fernandez, J., et al. (2002) Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology, 35, 140-148. doi:10.1053/jhep.2002.30082
[8] Mehta, A.K. and Lyon, G.M., 3rd 2010) Infectious diseases in end-stage liver disease patients. Critical Care Nursing Clinics of North America, 22, 291-307. doi:10.1016/j.ccell.2010.04.002
[9] Bernardi, M., (2010) Spontaneous bacterial peritonitis: From pathophysiology to prevention. Internal and Emergency Medicine, 5, S37-S44. doi:10.1007/s11739-010-0446-x
[10] Cano, R., et al. (2010) Proteomic evidence of bacterial peptide translocation in afebrile patients with cirrhosis and ascites. Journal of Molecular Medicine (Berl), 88, 487-495. doi:10.1007/s00109-009-0582-9
[11] Christou, L., Pappas, G. and Falagas, M.E. (2007) Bacterial infection-related morbidity and mortality in cirrhosis. The American Journal of Gastroenterology, 102, 1510-1517. doi:10.1111/j.1572-0241.2007.01286.x
[12] Cirera, I., et al. (2001) Bacterial translocation of enteric organisms in patients with cirrhosis. Journal of Hepatology, 34, 32-37. doi:10.1016/S0168-8278(00)00013-1
[13] Steed, H., et al. (2011) Bacterial translocation in cirrhosis is not caused by an abnormal small bowel gut microbiota. FEMS Immunology & Medical Microbiology, 63, 346-354. doi:10.1111/j.1574-695X.2011.00857.x
[14] Mesquita, M.A., et al. (1997) Ceftriaxone in the treatment of spontaneous bacterial peritonitis: Ascitic fluid polymorphonuclear count response and short-term prognosis. Hepato-Gastroenterology, 44, 1276-1280.
[15] Franca, A., et al., (2002) Five days of ceftriaxone to treat spontaneous bacterial peritonitis in cirrhotic patients. Journal of Gastroenterology, 37, 119-122. doi:10.1007/s005350200006
[16] Franca, A.V., et al. (2001) Long-term prognosis of cirrhosis after spontaneous bacterial peritonitis treated with ceftriaxone. Journal of Clinical Gastroenterology, 33, 295-298. doi:10.1097/00004836-200110000-00007
[17] Child, C.G. (1964) The liver and portal hypertension. Major problems in clinical surgery. Saunders, Philadelphia, 231 p.
[18] Pugh, R.N., et al. (1973) Transection of the oesophagus for bleeding oesophageal varices. British Journal of Surgery, 60, 646-649. doi:10.1002/bjs.1800600817
[19] Wiesner, R.H., et al. (2001) MELD and PELD: Application of survival models to liver allocation. Liver Transplantation, 7, 567-580. doi:10.1053/jlts.2001.25879
[20] Kamath, P.S., et al. (2001) A model to predict survival in patients with end-stage liver disease. Hepatology, 33, 464-470. doi:10.1053/jhep.2001.22172
[21] Rimola, A., et al. (2000) Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: A consensus document. International Ascites Club. Journal of Hepatology, 32, 142-153. doi:10.1016/S0168-8278(00)80201-9
[22] Kaplan, E.L. (1983) Citation Classic—Nonparametric estimation from Incomplete Observations. Current Contents/Life Sciences, 24, 14.
[23] Christensen, E., (1987) Multivariate survival analysis using Cox’s regression model. Hepatology, 7, 1346-1358. doi:10.1002/hep.1840070628
[24] Feldman, M., Friedman, L.S. and Sleisenger, M.H. (2002) Sleisenger & Fordtran’s gastrointestinal and liver disease: Pathophysiology, diagnosis, management. 7th Edition, Saunders, Philadelphia, 98 p.
[25] de Mattos, A.A., et al. (2003) Bacterial infection in cirrhotic patient. Arquivos de Gastroenterologia, 40, 11-15. doi:10.1590/S0004-28032003000100003
[26] Strauss, E. and de Sa Ribeiro Mde, F.G. (2003) Bacterial infections associated with hepatic encephalopathy: Prevalence and outcome. Annals of Hepatology, 2, 41-45.
[27] Strauss, E. and Aerosa, J.P. (2004) Alcoholic hepatitis: Bad prognosis due to concomitant bacterial infections. Revista da Sociedade Brasileira de Medicina Tropical, 37, 199-203. doi:10.1590/S0037-86822004000300001
[28] Moore, K.P. andAithal, G.P. (2006) Guidelines on the management of ascites in cirrhosis. Gut, 55, vi1-vi12. doi:10.1136/gut.2006.099580
[29] Maheshwari, A. and Thuluvath, P.J. (2005) Autonomic neuropathy may be associated with delayed orocaecal transit time in patients with cirrhosis. Autonomic Neuroscience, 118, 135-139. doi:10.1016/j.autneu.2005.02.003
[30] Chesta, J. and Defilippi, C. (1993) Abnormalities in proximal small bowel motility in patients with cirrhosis. Hepatology, 17, 828-832.
[31] Madrid, A.M., et al. (1998) Small bowel motility in primary biliary cirrhosis. The American Journal of Gastroenterology, 93, 2436-2440. doi:10.1111/j.1572-0241.1998.00700.x
[32] Moller, S., et al. (2007) Reduced baroreflex sensitivity in alcoholic cirrhosis: relations to hemodynamics and humoral systems. American Journal of Physiology—Heart and Circulatory Physiology, 292, H2966-H2972. doi:10.1152/ajpheart.01227.2006
[33] Nagasako, C.K., et al. (2009) Investigation of autonomic function and orocecal transit time in patients with nonalcoholic cirrhosis and the potential influence of these factors on disease outcome. Journal of Clinical Gastroenterology, 43, 884-889. doi:10.1097/MCG.0b013e31818de34c
[34] Bellot, P., et al. (2010) Bacterial DNA translocation is associated with systemic circulatory abnormalities and intrahepatic endothelial dysfunction in patients with cirrhosis. Hepatology, 52, 2044-2052. doi:10.1002/hep.23918
[35] Bercoff, E., et al. (1985) Urinary tract infection in cirrhotic patients, a urodynamic explanation. Lancet, 1, 987. doi:10.1016/S0140-6736(85)91764-7
[36] Almeida, D., et al. (2001) Comparative study of bacterial infection prevalence between cirrhotic patients with and without upper gastrointestinal bleeding. Brazilian Journal of Infectious Diseases, 5, 136-142. doi:10.1590/S1413-86702001000300006
[37] Bernard, B., et al. (1995) Prognostic significance of bacterial infection in bleeding cirrhotic patients: A prospective study. Gastroenterology, 108, 1828-1834. doi:10.1016/0016-5085(95)90146-9
[38] Vivas, S., et al. (2001) Presence of bacterial infection in bleeding cirrhotic patients is independently associated with early mortality and failure to control bleeding. Digestive Diseases and Sciences, 46, 2752-2757. doi:10.1023/A:1012739815892
[39] Fasolato, S., et al. (2007) Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features. Hepatology, 45, 223-229. doi:10.1002/hep.21443
[40] Terg, R., et al. (2009) Serum creatinine and bilirubin predict renal failure and mortality in patients with spontaneous bacterial peritonitis: a retrospective study. Liver International, 29, 415-419. doi:10.1111/j.1478-3231.2008.01877.x
[41] Heuman, D.M., et al. (2004) Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology, 40, 802-810.
[42] Sort, P., et al. (1999) Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. The New England Journal of Medicine, 341, 403-409. doi:10.1056/NEJM199908053410603
[43] Deschenes, M. and Villeneuve, J.P. (1999) Risk factors for the development of bacterial infections in hospitalized patients with cirrhosis. The American Journal of Gastroenterology, 94, 2193-2197.
[44] European Association for the Study of the Liver (2010) EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Journal of Hepatology, 53, 397- 417. doi:10.1016/j.jhep.2010.05.004
[45] Kim, B.I., et al. (2011) Increased intestinal permeability as a predictor of bacterial infections in patients with decompensated liver cirrhosis and hemorrhage. Journal of Gastroenterology and Hepatology, 26, 550-557. doi:10.1111/j.1440-1746.2010.06490.x

  
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