Prevalence, predictors and impact of bacterial infection in acute on chronic liver failure patients

Shalimar, S.; Rout, G. R.; Jadaun, Shekhar Singh; Ranjan, Gyan; Kedia, Saurabh; Gunjan, Deepak; Nayak, Baibaswata; Acharya, Subrat Kumar; Kumar, Ajay; Kapil, Arti

doi:10.1016/j.dld.2018.05.013

Cited by 42 publications

(39 citation statements)

References 19 publications

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“…[33][34][35] Further, infectious complication has been proven to accelerate the deterioration of ACLF, thus contributing to the exceedingly high mortality of ACLF patients. [36][37][38] Our study also confirmed the significantly increased mortality in patients with infection. However, we found that the infection rate did not increase in the ALSS group and that the survival rate significantly improved in ACLF patients with infections in the ALSS group.…”

Section: Discussionsupporting

confidence: 83%

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

et al. 2020

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Hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) is difficult to treat and carries a high risk of short‐term mortality. This study aimed to explore the effect of artificial liver support system (ALSS) on the survival of HBV‐ACLF patients and to investigate which HBV‐ACLF patients may benefit from ALSS treatment. We enrolled 132 patients hospitalized for HBV‐ACLF according to the criteria of the Chinese Group on the Study of Severe Hepatitis B‐ACLF (COSSH‐ACLF) from 425 ACLF patients who were determined to at least meet the Asian Pacific Association for the Study of the Liver criteria and followed up for 90 days. Overall 132 eligible patients were divided into two groups: standard medical treatment (SMT) group, which included 54 patients who underwent SMT alone, and ALSS group, which included 78 patients who underwent ALSS treatment plus SMT. The proportion of HBV‐ACLF grade 1, 2, and 3 was 57.69%, 37.18%, and 5.13% in the ALSS group and 51.85%, 35.19%, and 12.96% in the SMT group, respectively. Bacterial infection was present in 43.6% of patients in the ALSS group and in 55.6% of patients in the SMT group. The mortality rates in the ALSS group at 28 and 90 days were significantly lower than those in the SMT group (23.08% vs. 48.15% and 33.33% vs. 57.41%, P < 0.05). ALSS was an independent factor related to both the 28‐ and 90‐day survival of HBV‐ACLF patients. Particularly, a higher cumulative survival rate in either patients with HBV‐ACLF grade 1 or those with HBV‐ACLF with bacterial infection was observed in the ALSS group. Moreover, ALSS had an independent influence on mortality. Based on the COSSH‐ACLF criteria, ALSS could better improve the short‐term survival of HBV‐ACLF patients than SMT alone, especially in those with HBV‐ACLF grade 1 or HBV‐ACLF with infection.

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Section: Discussionsupporting

confidence: 83%

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

et al. 2020

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“…We found that the proportion of patients with COVID-19 with alcohol etiology was less as compared to our previous experience [20]. In the pre-COVID era, the highest fraction of CLD patients admitted was due to alcohol etiology [9]. Lockdown was implemented by the Indian government, and alcohol was not available; this could be a reason, and another possible reason could be the fact the borders of the states were sealed, which would reduce the number of patients reaching the hospital.…”

Section: Discussioncontrasting

confidence: 58%

“…We compared the results of COVID positive patients with age, sex, and severity matched cirrhosis patients (historical controls) from previously published data from our center [9,10].…”

Section: Patient Populationmentioning

confidence: 99%

Poor Outcomes in Patients with Cirrhosis and COVID-19

Shalimar

Elhence

Vaishnav

et al. 2020

Preprint

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Abstract Background and AimThere is a paucity of data on the clinical presentations and outcomes of Coronavirus disease 2019(COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19 positive patients and compare with historical controls.MethodsPatients with known chronic liver disease who presented with superimposed COVID- 19(n=28) between 22nd April and 22nd June 2020 were studied. Seventy-eight cirrhotic patients from historical controls were taken as comparison group.ResultsA total of 28 COVID patients- two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation (AD), and nine with acute-on-chronic liver failure(ACLF) were included. The etiology of cirrhosis was alcohol(n=9), non-alcoholic fatty liver disease(n=2), viral(n=5), autoimmune hepatitis(n=4), and cryptogenic cirrhosis(n=6). The clinical presentations included complications of cirrhosis in 12(46.2%), respiratory symptoms in 3(11.5%) and combined complications of cirrhosis and respiratory symptoms in 11(42.3%) patients. The median hospital stay was 8(7-12) days. The mortality rate in COVID-19 patients was 42.3%(11/26), as compared to 23.1%(18/78) in the historical controls(p=0.077). All COVID-19 patients with ACLF(9/9) died compared to 53.3%(16/30) in ACLF of historical controls(p=0.015). Mortality rate was higher in COVID patients with compensated cirrhosis and AD as compared to historical controls 2/17(11.8%) vs 2/48(4.2%), though not statistically significant (p=0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio, 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.ConclusionCOVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.

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“…Usually, infection is not only the trigger of ACLF but also a common complication in patients with ACLF. Once an infection occurred, the mortality rate increased signi cantly [4,5] . Excessive in ammation response induced by infection can cause multiorgan failure and death.…”

Section: Discussionmentioning

confidence: 99%

Infection deteriorating hepatitis B virus related acute-on-chronic liver failure: a retrospective cohort study

Zhai

Tong

Wang

et al. 2020

Preprint

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Background: Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. However, the characteristics of infection and its influence on prognosis in hepatitis B virus related ACLF (HBV-ACLF) as defined by the European Association for the Study of the Liver (EASL) have not been clarified. We aimed to investigate the characteristics of infection and its influence on mortality in patients with HBV-ACLF defined by EASL in China.Methods: We performed a retrospective cohort study in patients with HBV-ACLF defined by EASL in a single center from January 2015 to December 2017. These patients were divided into two groups with and without infection. The incidence, sites of infection, isolated strains, and risk factors associated with mortality were evaluated. Results: A total of 289 patients were included, among them 185 (64.0%) were diagnosed with an infection. The most common type of infection was pneumonia (55.7%), followed by spontaneous bacterial peritonitis (47.6%) and others. The gram-negative bacteria were the most frequent (58.3%). Patients with one, two, and three or more infection sites had a gradually increasing incidence of sepsis (P<0.01), septic shock (P<0.001), and ACLF-3 (P<0.05). Also, patients with infection isolated one, two, and three or more strains showed a growing incidence of sepsis (P<0.01) and septic shock (P<0.001). Patients with infection showed a significantly higher 28-day mortality than those without (P<0.01), especially in patients with ACLF-3. Infection was identified as an independent risk factor for 28-day mortality in all HBV-ACLF patients. Pneumonia and sepsis were identified as independent predictors of 28-day mortality for patients with infection.Conclusions: Infection is associated with severe clinical course and high mortality in HBV-ACLF defined by EASL. The increased number of infection sites or isolated strains was associated with the occurrence of sepsis and septic shock. Pneumonia and sepsis were independent predictors for mortality in HBV-ACLF patients with infection.

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Prevalence, predictors and impact of bacterial infection in acute on chronic liver failure patients

Cited by 42 publications

References 19 publications

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Poor Outcomes in Patients with Cirrhosis and COVID-19

Infection deteriorating hepatitis B virus related acute-on-chronic liver failure: a retrospective cohort study

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