Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
MELD, PROTEIN MALNUTRITION AND PREVIOUS INFECTIONS ARE PREDICTORS OF BACTERIAL INFECTIONS AND SEPSIS IN CIRRHOTIC PATIENTS
V. Giannelli1*, C. Lucidi1, M. Giusto1, A. Ruffa1, O. Riggio1, L. Ridola1, M. Venditti2, A.F. Attili1, M. Merli1
1Gastroenterology. Dept of Clinical Medicine, 2Infectious and Tropical Diseases, University “La Sapienza” of Rome, Rome, Italy. *firstname.lastname@example.org
Background and aims: Bacterial infections are a frequent and serious complication in cirrhosis. An infection accompanied by Systemic Inflammatory Response Syndrome (SIRS), defined as Sepsis, increases the risk of liver failure and death. The severity of liver disease (Child Pugh C) is considered the only independent risk factor for infection (Am J Gastroenterol 2007;102:1510). This study was aimed to investigate additional risk factors for infection and sepsis in hospitalized cirrhotic patients.
Methods: Prospective study in a cohort of patients admitted at our University Hospital between October 2008 and July 2009. All episodes of infection and sepsis were diagnosed according to current guidelines. Demographic and clinical data (age, sex, origin of liver disease, nutritional status, active alcohol abuse, Child and MELD scores, hyposodiemia, concomitant diseases, previous hospitalization, previous infection episodes and antibiotic prophylaxis) were recorded. Protein malnutrition was diagnosed based on Mid-Arm Muscle Circumference < 5thcentile.
Results: 150 cirrhotic patients (68%males; age64±13yrs; 31%ChildC; 33% MELD≥15) were enrolled in the study. 55 infections were recorded in 50 patients: 34 community-acquired and 16 nosocomial. The episodes of infection were: urinary tract infection (36%) , pneumonia (22%), spontaneous bacteremia (13%), spontaneous bacterial peritonitis (8%), cholangitis (5%) and others sites (16%). Coltures were positive in 26 cases: Gram(-) bacteria in 62% and Gram(+) in 38%. Gram(+) bacteria were prevalent in nosocomial infections. At multivariate analysis, independent risk factors for infection were: MELD≥15 (p=.001; OR 2,8; 95% CI 1,3-6,1), protein malnutrition (p=.000; OR 4,5; 95% CI 1,8-10,3) and previous infections in the last 12 months (p=.000: OR 4,7; 95% CI 2,2-10,6) and for sepsis were: MELD≥15 (p=.001; OR 4,4; 95% CI 1,8-10), protein malnutrition (p=.004; OR 4; 95% CI 1,5-10) and previous infections in the last 12 months (p=.007: OR 3,4; 95% CI 1,3-8,1). Child C turned out to be a weaker risk factor compared with MELD≥15.
Conclusion: Our study shows that a history of recent infection, severity of liver disease and nutritional status are important predictors for infections and sepsis. Further studies are needed to assess the role of preventive therapies in patients identified by these risk factors.