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- Title
Prognostic Role of Bacterial and Fungal Infections in Patients With Liver Cirrhosis With and Without Acute-on-Chronic Liver Failure: A Prospective 2-Center Study.
- Authors
Bartoletti, Michele; Baldassarre, Maurizio; Domenicali, Marco; Lewis, Russell E; Giannella, Maddalena; Antognoli, Agnese; Rinaldi, Matteo; Zaccherini, Giacomo; Verucchi, Gabriella; Marconi, Lorenzo; Tamè, Mariarosa; Berardi, Sonia; Napoli, Lucia; Siniscalchi, Antonio; Fabbri, Angela; Biselli, Maurizio; Tufoni, Manuel; Pavarin, Raimondo M; Trevisani, Franco; Viale, Pierluigi
- Abstract
Background Bacterial and fungal infections (BFIs) are frequent in patients with cirrhosis and often trigger acute-on-chronic liver failure (ACLF). This prospective observational study aims to describe the interactions between BFI and ACLF in terms of mortality and related risk factors. Methods We performed a 2-center prospective observational study enrolling hospitalized patients with cirrhosis admitted for acute decompensation. Data were recorded at admission and during hospitalization. Survival was recorded up to 1 year. Results Among the 516 patients enrolled, 108 (21%) were infected at admission, while an additional 61 patients (12%) developed an infection during hospital stay. In the absence of ACLF, the 1-year mortality rate of patients with BFI did not differ from that of patients without BFI (33% vs 31%; P = .553). In contrast, those with ACLF triggered or complicated by BFI had a significantly higher mortality rate than those who remained free from BFI (75% vs 54%; P = .011). Competing risk analysis showed that the negative impact of ACLF-related BFI on long-term prognosis was independent from Model for End-stage Liver Disease (MELD) incorporating serum sodium concentration score, comorbidity, and basal C-reactive protein level. Finally, multivariable logistic regression showed that higher MELD score (P < .001), QuickSOFA score ≥2 points (P = .007), and secondary bloodstream (P = .022) and multidrug-resistant pathogen isolation (P = .030) were independently associated with ACLF in patients with BFI. Conclusions This large prospective study indicated that the adverse impact of BFI on long-term survival in decompensated cirrhosis is not universal but is limited to those patients who also develop ACLF. Both disease severity and microbiological factors predispose infected decompensated patients to ACLF.
- Subjects
MYCOSES; BACTERIAL diseases; CIRRHOSIS of the liver; LIVER failure; LONGITUDINAL method
- Publication
Open Forum Infectious Diseases, 2020, Vol 7, Issue 11, p1
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofaa453