The Risk Factors for Mortality in Deceased Donor Liver Transplant Recipients With Bloodstream Infections

Wan, Qiquan; Ye, Q.F.; Ming, Yingzi; Ma, Yue; Zhou, Jianda; Qiao, Bingbing

doi:10.1016/j.transproceed.2012.06.080

Cited by 20 publications

(11 citation statements)

References 13 publications

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“…We also revealed that increased serum creatinine level affected survival of ASOT recipients with MDR GNB. This finding was accordant with previous studies of SOT recipients with BSI revealing that renal dysfunction was related to increased mortality [ 5 , 33 , 53 , 64 ]. A recent study of SOT recipients with BSI also reported that renal impairment (a serum creatinine level of >1.5 mg/dL) was more frequent among non-survivors [ 42 ].…”

Section: Discussionsupporting

confidence: 92%

“…We found that septic shock led to a 160-fold increase in mortality and was the strongest predictor of patient outcomes in multivariate models. This association of septic shock with mortality echoed the findings of our previous study [ 53 – 55 ] and other studies [ 26 , 42 , 56 , 57 ] based on SOT recipients with BSI. Septic shock is the most severe complication in the context of BSI in SOT recipients and improving the management of septic shock remains a great challenge [ 2 , 42 ].…”

Section: Discussionsupporting

confidence: 89%

“…Consistent with a previous study [ 5 ] based on SOT recipients with BSI, the present study indicated that presence of other concomitant BSI was another risk factor which contributed to mortality. Our previous studies found polymicrobial was a risk factor for BSI-related mortality in deceased donor liver or SOT recipients in the univariate analysis whereas this association did not remain in the multivariate analysis [ 51 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Qiao

Wan

et al. 2017

BMC Infect Dis

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BackgroundAlthough multidrug-resistant (MDR) gram-negative bacteremia (GNB) has been recognized as an important cause of morbidity and mortality among abdominal solid organ transplant (ASOT) recipients, there are no data on its prognostic factors after an interim standard definition of MDR was proposed in 2012. The objective of this study was to describe the epidemiology, microbiology, and predictors of infection-related 30-day mortality in ASOT recipients with MDR GNB.MethodsWe performed a retrospective, double-center analysis of ASOT patients with MDR GNB over a 13-year study period. Univariate and multivariate analyses were performed to identify the risk factors for mortality.ResultsDuring the observational period, 2169 subjects underwent ASOT. Ninety-nine episodes of MDR GNB were diagnosed in 91 (4.6%) ASOT recipients, with a predominance of E.coli (29 isolates, 29.3%) and A.baumanii (24 isolates, 24.2%). The median age of these 91 recipients was 45 years (interquartile range 35–54). Mortality after the first episode of MDR GNB was 39.6% (36 deaths). The univariate analysis identified the following variables as predictors of MDR GNB-related mortality: lung focus (P = 0.001),nosocomial origin (P = 0.002), graft from donation after cardiac death or deceased donors (P = 0.023), presence of other concomitant bloodstream infection (P < 0.001), temperature of 40 °C or greater at the onset of MDR GNB (P = 0.039), creatinine > 1.5 mg/dl (P = 0.006), albumin < 30 g/L (P = 0.009), platelet count < 50,000/mm3 (P < 0.001), and septic shock (P < 0.001). In the multivariate logistic regression analysis, septic shock (odds ratio (OR) = 160.463, 95% confidence interval (CI) = 19.377–1328.832, P < .001), as well as creatinine > 1.5 mg/dl (OR = 24.498, 95% CI = 3.449–173.998, P = 0.001), nosocomial origin (OR = 23.963, 95% CI = 1.285–46.991, P = 0.033), and presence of other concomitant bloodstream infections (OR = 27.074, 95% CI = 3.937–186.210, P = 0.001) were the variables associated with MDR GNB-related 30-day mortality.ConclusionsMDR GNB was associated with high morbidity and mortality in ASOT recipients, with a predominant causative organisms being E.coli and A.baumanii. Nosocomial origin, as well as presence of other concomitant bloodstream infections, increased creatinine level and septic shock were the main predictors of MDR GNB-related 30-day mortality.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Qiao

Wan

et al. 2017

BMC Infect Dis

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“…The exact mechanisms of this interaction in sepsis are not clearly understood, although there is increasing evidence that they play an important role in the development of multiple organ failure and disseminated intravascular coagulation [26]. A lower platelet count has previously been identified as an unadjusted risk factor for mortality in some retrospective studies in SOT recipients with BSI [27,28].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing mortality in solid organ transplant recipients with bloodstream infection

Oriol¹,

Sabé²,

Melilli³

et al. 2015

Clinical Microbiology and Infection

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Although bloodstream infection (BSI) is a major cause of mortality after solid organ transplantation, information regarding its prognostic factors is scarce. To identify risk factors for 30-day mortality in solid organ transplant (SOT) recipients with BSI, we prospectively recorded all episodes of BSI occurring in adult SOT recipients from January 2007 to October 2014 at a university hospital. We identified 361 consecutive episodes of BSI involving 246 patients. The 30-day case-fatality rate from the onset of BSI was 11.4%. Factors independently associated with 30-day mortality in a logistic regression analysis were shock at presentation (OR 13.658; 95% CI 5.985-31.168), acute graft rejection in the previous 6 months (OR 3.681; 95% CI 1.059-12.795), and a platelet count of <50,000 × 10(9)/L (OR 3.070; 95% CI 1.173-8.038). Kidney recipients were the patients with the best prognosis (OR 0.375; 95% CI 0.156-0.900). Our findings may help to identify SOT recipients with BSI who are at the highest risk of death.

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“…34 The cut off value of serum creatinine (>1.5 mg/dL) as a marker of renal dysfunction was basis on previous studies. 35,36 Septic shock was diagnosed as hypotension unresponsive to intravenous fluid challenge with the need for vasopressor. 16 Infection-related mortality was determined when it related to clinical signs of active infection, and when there was no evidence of any other attributable cause.…”

Section: Definitionsmentioning

confidence: 99%

Mortality predictors in recipients developing acute respiratory distress syndrome due to pneumonia after kidney transplantation

Zhang

Wan

et al. 2016

Renal Failure

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The Risk Factors for Mortality in Deceased Donor Liver Transplant Recipients With Bloodstream Infections

Cited by 20 publications

References 13 publications

Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Factors influencing mortality in abdominal solid organ transplant recipients with multidrug-resistant gram-negative bacteremia

Factors influencing mortality in solid organ transplant recipients with bloodstream infection

Mortality predictors in recipients developing acute respiratory distress syndrome due to pneumonia after kidney transplantation

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