Background & Aims: Severe acute liver injury (ALI) precedes acute liver failure (ALF). Risk factors related to ALI progression to ALF or death, are not well-known. We aimed to investigate which predictors of poor outcomes can be identified in patients with ALI. Methods: We retrospectively analyzed 59 patients with ALI diagnosis, admitted from 2010 to 2021 in our Intermediate Medical Care Unit, and checked for clinical, biochemical and imagiological data, in order to explore their relationship with progression to ALF or death. Results: From the 59 patients with ALI, 11 (18.6%) evolved to ALF and 9 (15.3%) died during the hospital staying or within the first month after discharge. Not having drug-induced liver injury or ischemic hepatitis as etiological factors was associated to increased progression to ALF (hazard ratio [HR] 0.17; 95% confidence interval [CI]: 0.03-0.96; P=0.041). In univariate analysis, ascites related to development to ALF (HR 0.25; 95% CI: 0.06-0.97; P=0.037) and death (HR 7.09; 95% CI: 1.55-33.04; P=0.006), while renal dysfunction, was only allied to death (HR 0.99; 95% CI: 0.97-1.00; P=0.035). Inflammatory markers at admission were not linked to progression to ALF. Yet, increased C reactive-protein levels were commonly found in patients who died (HR 1.01; 95% CI: 1.00-1.03; P=0.035). In multivariate analysis, only ascites remained significant (P=0.005) as predictor of death. Conclusions: In patients with ALI, ascites at presentation is the only marker of poor prognosis (mainly to death). Still, those who are more inflamed or have renal dysfunction at baseline are more willing to die.
Background:
The emergence of carbapenemase-producing Enterobacterales (CPE) represents a major public health threat. Our purpose was to evaluate a surveillance and cohorting program implemented in patients infected or carriers of CPE.
Methods:
A prospective registry of CPE carriers or infected patients was analyzed from October 2015 until December 2017. All inpatients presenting with CPE were included in a hospital cohort with dedicated healthcare staff and contact precaution measures.
Results:
A total of 480 patients were identified, of which 15.8% (n = 76) were infected. Men comprised 56.7% of the cohort (n = 272) and 69.2% (n = 332) were elderly. About 46.3% (n = 222) had a previous hospital admission and 81.7% (n = 392) had at least 1 antibiotic course in the previous 90 days. There was a decline in infected patients in 2017. Periodic and admission screenings accounted for 63% and 74% of cases in 2016 and 2017, with increased detection rate comparing with contact/investigation screenings. In 2017, significantly fewer patients were identified outside the admission/point of prevalence screening (
P
= .009). In 2017 the proportion of invasive carbapenem-resistant
Klebsiella pneumoniae
amongst CPE in our center was below the national average (2016: 13.3% vs 5.2%; 2017: 6.6% vs 8.6%). A reduction of the consumption of carbapenems was also observed in 2017.
Conclusion:
The implementation of the program has increased the number of patients identified by the preventive method and stabilized the emergence of new CPE cases. Furthermore, the program cohort compared well with the national picture, with a lower number of infected patients and a lower proportion of carbapenem-resistant
K pneumoniae
in invasive specimens. These indicators reflect the added value of the CPE surveillance and cohorting program.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.