Predictors of mortality among patients with compensated and decompensated liver cirrhosis: the role of bacterial infections and infection-related acute-on-chronic liver failure

Sargenti, Konstantina; Prytz, Hanne; Nilsson, Emma; Kalaitzakis, Evangelos

doi:10.3109/00365521.2015.1017834

Cited by 56 publications

(33 citation statements)

References 32 publications

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“…In fact, Asian Pacific Association for the Study of the Liver only considers variceal bleeding a precipitant if it results in liver failure, whereas the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases consider it as a precipitant in all cases . Either way, it is suspected that acute variceal bleeding precipitates ACLF mainly due to hepatic ischemia, increased bacterial translocation from the gut, and subsequent bacterial infections . The prevalence of variceal bleeding as the precipitant of ACLF ranges from 13% to 28% of patients depending on the study .…”

Section: Gi Hemorrhagementioning

confidence: 99%

Precipitants of Acute‐on‐Chronic Liver Failure: An Opportunity for Preventative Measures to Improve Outcomes

et al. 2020

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Acute-on-chronic liver failure (ACLF) is a feared complication that can develop at any stage of chronic liver disease. The incidence of ACLF is increasing, leading to a significant burden to both the affected individual and health care systems. To date, our understanding of ACLF suggests that it may be initiated by precipitants such as systemic infection, alcohol use, or viral hepatitis. The prevalence of these vary significantly by geography and underlying liver disease, and these precipitants have a varying impact on patient prognosis. Herein, we present a review of our current understanding of the precipitants of ACLF, including gaps in current data and opportunities for meaningful intervention and areas of future research. Liver Transplantation 26 283-293 2020 AASLD.liveR tRAnsplAntAtion, vol. 26, no. 2, 2020 cullARo et Al.

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Section: Gi Hemorrhagementioning

confidence: 99%

Precipitants of Acute‐on‐Chronic Liver Failure: An Opportunity for Preventative Measures to Improve Outcomes

et al. 2020

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“…17 Other 2 studies suggest that nosocomial infections are independent predictors of ACLF. 18,19 Type and severity of infections were partially described in these studies with no mention on other characteristics of bacterial infections, microbiology and relationship with clinical course.…”

Section: Introductionmentioning

confidence: 99%

Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

Fernández¹,

Acevedo²,

Wiest³

et al. 2017

Journal of Hepatology

103

187

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“…Previous studies have shown that the presence of DC independently increases mortality rates for other gastrointestinal diseases, including diverticulitis, peptic ulcer disease, Clostridium difficle infections, [25][26][27] along with non-gastrointestinal bacterial infections. 28 This appears to be the case for ABP as well. Additional risk factors for mortality during index hospitalization include increasing age, sepsis, and SAP, all of which are known risk factors for mortality in acute pancreatitis, with an augmented effect in cirrhosis patients.…”

Section: Discussionmentioning

confidence: 83%

Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis

Patel

Mumtaz

et al. 2019

J of Gastro and Hepatol

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Background and Aim Despite higher rates of gallstones in patients with cirrhosis, there are no population‐based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high‐risk population. Methods We utilized the Nationwide Readmission Database (2011–2014) to evaluate all adults admitted with ABP. Multivariable logistic regression models were used to assess independent predictors for 30‐day readmission, index admission mortality, and calendar year mortality. Results Among 184 611 index admissions with ABP, 4344 (2.4%) subjects had cirrhosis (1649 with decompensation). Subjects with cirrhosis, when compared with those without, incurred higher rates of 30‐day readmission (20.9% vs 11.2%; P < 0.001), index mortality (2.0% vs 1.0%; P < 0.001), and calendar year mortality (4.2% vs 0.9%; P < 0.001). Decompensation in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; P < 0.001) and endoscopic retrograde cholangiopancreatographies (23.3% vs 29.9%; P < 0.001). Multivariate analysis revealed that severe acute pancreatitis (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 5.3, 41.2), sepsis (OR: 12.6; 95% CI: 5.8, 27.4), and decompensation (OR: 3.1; 96% CI: 1.4, 6.6) were associated with increased index admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1, 3.0) and 30‐day readmission (OR: 5.6; 95% CI: 3.3, 9.5) were predictors of calendar year mortality. However, index admission cholecystectomy was associated with decreased 30‐day readmissions (OR: 0.6; 95% CI: 0.4, 0.7) and calendar year mortality (OR: 0.44; 95% CI: 0.25, 0.78). Conclusions The presence of cirrhosis adversely impacts hospital outcomes of patients with ABP. Among modifiable factors, index admission cholecystectomy portends favorable prognosis by reducing risk of early readmission and consequent calendar year mortality.

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Predictors of mortality among patients with compensated and decompensated liver cirrhosis: the role of bacterial infections and infection-related acute-on-chronic liver failure

Cited by 56 publications

References 32 publications

Precipitants of Acute‐on‐Chronic Liver Failure: An Opportunity for Preventative Measures to Improve Outcomes

Precipitants of Acute‐on‐Chronic Liver Failure: An Opportunity for Preventative Measures to Improve Outcomes

Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis

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