Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017

Shankar, Nagasri; Ramani, Ananthakrishnan; Griffin, Connor; Agbim, Uchenna; Kim, Dong‐Hee; Ahmed, Aijaz; Asrani, Sumeet K.

doi:10.1016/j.aohep.2021.100565

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…In a general medical population, ischaemic heart disease, cancer, and COPD are likely to have the greatest impact on mortality;cirrhosis, mortality may be influenced more by kidney disease, infections, falls, delirium, and social determinants of health. 25 , [31] , [32] , [33] , [34] , [35] , [36] , [37] Compared with the other indices, HFRS is unique in its inclusion of social conditions, infections, falls/trauma, and dementia/delirium. Furthermore, although kidney disease and/or fluid and electrolyte disorders are present in all four indices, we note striking differences in their prevalence’s across the indices.…”

Section: Discussionmentioning

confidence: 99%

Hospital frailty risk score is superior to legacy comorbidity indices for risk adjustment of in-hospital cirrhosis cases

Desai,

Parvataneni,

Knapp

et al. 2024

JHEP Reports

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Section: Discussionmentioning

confidence: 99%

Hospital frailty risk score is superior to legacy comorbidity indices for risk adjustment of in-hospital cirrhosis cases

Desai,

Parvataneni,

Knapp

et al. 2024

JHEP Reports

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“…Details of causes of death were not available to assess whether deaths were driven by complications of liver disease or other causes. However, we recently reported on causes of death in compensated cirrhosis using national death data where we showed that extrahepatic causes of death (especially CVD) are important drivers of mortality and differentially affect cirrhosis compared with other chronic diseases (39). We did not analyze medications use in these patients, which could have potentially affected the outcomes especially with the highly prevalent and impactful nature of CVD in this study.…”

Section: Discussionmentioning

confidence: 99%

Comorbid Chronic Diseases and Survival in Compensated and Decompensated Cirrhosis: A Population-Based Study

et al. 2022

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INTRODUCTION:The burden of liver disease is substantial and increasing; the impact of comorbid chronic diseases on the clinical course of patients with compensated and decompensated cirrhosis is not well-defined. The aim of this study was to examine the individual and additive impact of comorbid chronic diseases on mortality in patients with cirrhosis.METHODS:In this population-based study, we used Cox proportional hazards modeling with time-dependent covariates to assess the impact of comorbid chronic diseases (diabetes mellitus, chronic kidney disease, and cardiovascular disease [CVD]) on mortality in patients with cirrhosis in a large, diverse Metroplex.RESULTS:There were 35,361 patients with cirrhosis (mean age 59.5 years, 41.8% females, 29.7% non-White, and 17.5% Hispanic ethnicity). Overall, the presence of chronic comorbidities was 1 disease (28.9%), 2 diseases (17.5%), and 3 diseases (12.6%) with a majority having CVD (45%). Adjusted risk of mortality progressively increased with an increase in chronic diseases from 1 (hazard ratio [HR] 2.5, 95% confidence interval [CI] 2.23–2.8) to 2 (HR 3.27.95% CI 2.9–3.69) to 3 (HR 4.52, 95% CI 3.99–5.12) diseases. Survival of patients with compensated cirrhosis and 3 chronic diseases was similar to subsets of decompensated cirrhosis (67.7% as compared with decompensated cirrhosis with 1–3 conditions, 61.9%–63.9%).DISCUSSION:In patients with cirrhosis, a focus on comorbid chronic disease(s) as potential management targets may help avoid premature mortality, regardless of etiology. Multidisciplinary care early in the clinical course of cirrhosis is needed in addition to the current focus on management of complications of portal hypertension.

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“…Sepsis has been the leading cause of the increase in liver-related mortality among patients with liver cirrhosis (LC) over the past decade [ 1 ]. Patients with LC have a 10-fold higher incidence of bacterial infections [ 2 ] compared to the general population, which is attributable to their dysregulated immune function, changes in the microbiome, and increase in bacterial translocation from the gut to the systemic circulation [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of multidrug-resistant bacteremia in liver cirrhosis

Kim,

Song,

Kang

et al. 2024

Korean J Intern Med

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Background/Aims: Improved knowledge of local epidemiology and predicting risk factors of multidrug-resistant (MDR) bacteria are required to optimize the management of infections. This study examined local epidemiology and antibiotic resistance patterns of liver cirrhosis (LC) patients and evaluated the predictors of MDR bacteremia in Korea.Methods: This was a retrospective study including 140 LC patients diagnosed with bacteremia between January 2017 and December 2022. Local epidemiology and antibiotic resistance patterns and the determinants of MDR bacteremia were analyzed using logistic regression analysis.Results: The most frequently isolated bacteria, from the bloodstream, were Escherichia coli (n = 45, 31.7%) and Klebsiella spp. (n = 35, 24.6%). Thirty-four isolates (23.9%) were MDR, and extended-spectrum beta-lactamase E. coli (52.9%) and methicillin-resistant Staphylococcus aureus (17.6%) were the most commonly isolated MDR bacteria. When Enterococcus spp. were cultured, the majority were MDR (MDR 83.3% vs. 16.7%, p = 0.003), particularly vancomycin-susceptible Enterococcus faecium. Antibiotics administration within 30 days and/or nosocomial infection was a significant predictor of MDR bacteremia (OR: 3.40, 95% CI: 1.24–9.27, p = 0.02). MDR bacteremia was not predicted by sepsis predictors, such as positive systemic inflammatory response syndrome (SIRS) or quick Sequential Organ Failure Assessment (qSOFA).Conclusions: More than 70% of strains that can be treated with a third-generation cephalosporin have been cultured. In cirrhotic patients, antibiotic administration within 30 days and/or nosocomial infection are predictors of MDR bacteremia; therefore, empirical administration of broad-spectrum antibiotics should be considered when these risk factors are present.

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Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017

Cited by 4 publications

References 32 publications

Hospital frailty risk score is superior to legacy comorbidity indices for risk adjustment of in-hospital cirrhosis cases

Hospital frailty risk score is superior to legacy comorbidity indices for risk adjustment of in-hospital cirrhosis cases

Comorbid Chronic Diseases and Survival in Compensated and Decompensated Cirrhosis: A Population-Based Study

Prevalence and predictors of multidrug-resistant bacteremia in liver cirrhosis

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