Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study

Gustot, Thierry; Felleiter, Peter; Pickkers, Peter; Sakr, Yasser; Rello, Jordi; Velissaris, Dimitrios; Pierrakos, Charalampos; Taccone, Fabio Silvio; Ševčík, Pavel; Moreno, Christophe; Vincent, Jean‐Louis

doi:10.1111/liv.12520

Cited by 87 publications

(80 citation statements)

References 25 publications

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“…A large multicentre epidemiological study reported culture positivity for fungi in 25% of patients with cirrhosis admitted to an intensive care unit (ICU) versus 19% in non-cirrhotic patients [10]. However, the significance of this finding is unclear, as there was no report on the incidence of frank invasive fungal disease (IFD) as opposed to colonization.…”

Section: Introductionmentioning

confidence: 99%

Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit

Theocharidou

Agarwal

Jeffrey

et al. 2016

Clinical Microbiology and Infection

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Bacterial infections in cirrhosis are common and associated with increased mortality, but little is known about fungal infections. The aim of this study, a sub-analysis of the Fungal Infection Risk Evaluation study, was to assess the incidence and implications of early invasive fungal disease (IFD) in patients with cirrhosis admitted to intensive care units (ICU). Clinical and laboratory parameters collected in the first 3 days of ICU stay for 782 patients with cirrhosis and/or portal hypertension were analysed and compared with those of 273 patients with very severe cardiovascular disease (CVD). The CVD patients had more co-morbidities and higher APACHE II scores. The overall incidence of IFD was similar in the two groups, but the incidence of IFD in ICU was higher in liver patients (1% versus 0.4%; p 0.025) as was fungal colonization (23.8% versus 13.9%; p 0.001). The ICU and in-hospital mortality, and length of stay were similar in the two groups. A higher proportion of liver patients received antifungal therapy (19.2% versus 7%; p <0.0005). There was no difference in mortality between colonized patients who received antifungal therapy and colonized patients who did not. The incidence of IFD in patients with cirrhosis in ICU is higher compared with another high-risk group, although it is still very low. This risk might be higher in patients with advanced liver disease admitted with acute-on-chronic liver failure, and this should be investigated further. Our data do not support prophylactic use of antifungal therapy in cirrhosis. Clinical Microbiology and Infection

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Section: Introductionmentioning

confidence: 99%

Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit

Theocharidou

Agarwal

Jeffrey

et al. 2016

Clinical Microbiology and Infection

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“…Liver cirrhosis is a serious risk factor for hospitalization due to infection and for sepsis-related mortality; in patients with advanced liver disease, prevalence of in-hospital infections amounts to 25-35% and to approximately 60% in patients admitted to the ICU [67][68][69]. In comparison to other ICU patient groups, the presence of liver cirrhosis renders subjects acquiring infections more susceptible to multi-system organ failure due to septic shock [69].…”

Section: Infection And/or Sepsismentioning

confidence: 99%

“…In comparison to other ICU patient groups, the presence of liver cirrhosis renders subjects acquiring infections more susceptible to multi-system organ failure due to septic shock [69]. Overall (listing the types of infections from most to least frequent), cirrhotic patients are prone to develop SBP, urinary tract infections, pneumonia, bacteremia, and skin/soft tissue infections [70].…”

Section: Infection And/or Sepsismentioning

confidence: 99%

Intensive Care Therapy for Patients with Advanced Liver Diseases

Katsounas

Canbay

2018

Visc Med

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Decompensated cirrhosis is characterized by high hospitalization rates and costs, frequent readmissions, and poor short-term survival. Patients admitted to the hospital with acute variceal bleeding and/or hepatic encephalopathy and/or renal dysfunction are at serious risk for developing infection and/or sepsis; in turn, this renders them highly susceptible to the development of multi-system organ failure. The lack of standardized intensive care unit management protocols in patients with cirrhosis along with only few data reports from longitudinal clinical trials makes it difficult for hepatologists and critical care specialists to provide uniform evidence for clinical practice that could safely consolidate favorable outcomes such as lower hospitalization rates and/or mortality. Based on a rigorous online search of the scientific literature as well as a longtime clinical experience of the authors in the field of hepatology and critical care medicine, this work represents a focused effort to elucidate the specific bio-morbidity of advanced liver diseases in relation to the aforementioned challenges in clinical management. Further meta-analyses and/or systematic reviews are needed to enable clinicians to develop more effective strategies to bridge patients with decompensated liver disease to recompensation or liver transplantation.

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“…The systemic inflammatory response syndrome (SIRS) is defined by the presence of at least two of the following criteria: (1) altered temperature, (2) elevated respiratory rate or hyperventilation, (3) tachycardia, and (4) altered white blood cell count (high, low, or immature forms) [67]. Sepsis is the most common cause of mortality in most intensive care units (ICUs) [68]. Due to the hyperdynamic circulation and complications of portal hypertension, the currently accepted clinical definition of SIRS and hence sepsis may not be entirely applicable to patients with cirrhosis or ACLF.…”

Section: Sepsis In Aclfmentioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study

Abstract: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.

Cited by 87 publications

References 25 publications

Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit

Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit

Intensive Care Therapy for Patients with Advanced Liver Diseases

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

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