Clinical Characteristics and Prognostic Impact of Bacterial Infection in Hospitalized Patients with Alcoholic Liver Disease

Abstract

Bacterial infection is an important cause of death in patients with liver cirrhosis. The aim of this study was to investigate the clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease (ALD). We retrospectively analyzed data from 409 patients consecutively admitted to a tertiary referral center with ALD diagnosis. Of a total of 544 admissions, 133 (24.4%) cases presented with bacterial infection, of which 116 were community-acquired whereas 17 were hospital-acquired. The common types of infection were pneumonia (38%), biliary tract infection (17%), soft tissue infection (12%), and spontaneous bacterial peritonitis (9%). Diabetes, serum Na <135 mM/L, albumin <2.5 g/dL, C-reactive protein ≥20 mg/L, systemic inflammatory response syndrome (SIRS) positivity were independently associated with bacterial infection in patients with ALD. Overall 30-day and 90-day mortalities in patients with bacterial infection were significantly (P < 0.001) higher than those without infection (22.3% vs. 5.1% and 32.3% vs. 8.2%, respectively). Furthermore, bacterial infection (HR, 2.2; 95% CI, 1.049-4.579, P = 0.037), SIRS positivity (HR, 2.5; 95% CI, 1.240-4.861, P = 0.010), Maddrey's discriminant function score ≥32 (HR, 2.3; 95% CI, 1.036-5.222, P = 0.041), and hemoglobin <12 g/dL (HR, 2.4; 95% CI, 1.081-5.450, P = 0.032) were independent predictors of short-term mortality. In conclusion, bacterial infection and SIRS positivity predicted short-term prognosis in hospitalized patients with ALD. A thorough evaluation at admission or on clinical deterioration is required to detect possible infection with prompt management.Graphical Abstract

Clinical characteristics and prognostic factors of liver cirrhosis patients with systemic inflammatory response syndrome

“…Liver cirrhosis complicated with sepsis has the poorest prognosis. For example, patients with SBP that stems from pulmonary infection can progress to multiple infections and sepsis, bearing an increased mortality . Our study showed that multi‐site infections in patients with liver cirrhosis and SIRS were independent risk factors for death (HR = 19.427; CI, 7.484–50.431; P < 0.001).…”

“…For example, patients with SBP that stems from pulmonary infection can progress to multiple infections and sepsis, bearing an increased mortality. 3,34 Our study showed that multi-site infections in patients with liver cirrhosis and SIRS were independent risk factors for death (HR = 19.427; CI, 7.484-50.431; P < 0.001). We found that some cirrhotic patients with bacterial infection did not have SIRS and some patients with SIRS had nonbacterial infection.…”

Effect of SIRS and sepsis on mortality in alcoholic hepatitis: A systematic review and meta-analysis

“…Ten articles were excluded (two articles had no outcome of interest, while eight articles did not relate to a study in the subjects of interest). Data was extracted from six cohort studies (five retrospective cohort studies (5,13,14,19,20) and one prospective cohort study (4)) involving 1,264 patients (507 had SIRS), and four cohort studies (all retrospective cohort studies (3,14,21,22)) involving 57,529 patients (1,449 had sepsis). There were two studies assessing the mortality comparing AH patients with SIRS versus sepsis involving 527 patients (all retrospective cohort studies (5,13)).…”

“…Recent studies addressing the importance of SIRS in patients with AH have been conducted (5,13,14). Thus, to better characterize the effect of SIRS, we conducted a systematic review and meta-analysis of the observational studies in the literature that compared the risk of mortality in hospitalized patients with AH who had SIRS vs. non-SIRS as our primary outcome and sepsis vs. non-sepsis as our secondary outcome.…”

Molecular characterization and antibiotic sensitivity testing of bacteria in blood cultures of Hepatitis B virus infected subjects

“…Colonial and cellular morphology of the culture plates were observed, and necessary biochemical tests were carried out. 11 Antibiotics susceptibility test and ESBL screening This was done according to Clinical Laboratory Standard Institute (CLSI) Guidelines. 12 Standard antimicrobial discs for Gram negative and Gram positive organisms was placed onto the surface of the inoculated agar plates accordingly and incubated for 24 hours.…”