Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
BACTERIAL INFECTIONS AND SEPSIS ACUTELY DETERIORATE LIVER FUNCTION IN CIRRHOTIC PATIENTS: A PROSPECTIVE STUDY
C. Lucidi1*, V. Giannelli1, M. Giusto1, A. Ruffa1, P.A. Galtieri1, M. Venditti2, A.F. Attili1, O. Riggio1, 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 complication in cirrhosis. Infections accompanied by Systemic Inflammatory Response Syndrome (SIRS), defined as Sepsis, increases the risk of end-organ failure and death.(Hepatology 2009;50:2022). This study was aimed to investigate the clinical consequences of infections in hospitalized cirrhotic patients.
Patients/methods: Since October 2008 to July 2009 we consecutively enrolled a total of 150 cirrhotic patients (68% males; age 64±13yrs; 31% Child C; 33% MELD≥15) admitted at our University hospital. All episodes of bacterial infections and sepsis were recorded. Changes in liver function, clinical complications, length of hospital stay, protein malnutrition (Mid-Arm Muscle Circumference < 5thcentile) and survival were compared in infected and non-infected patients.
Results: During hospitalization 50 patients had a diagnosis of infection, 31 of whom recognized as sepsis. At the time of infection Child score deteriorated in 25 patients (mean increase=+1,9±0,9) and MELD score in 24 patients (mean increase=+3,75±2,7). The incidence of Hepato-Renal Syndrome (HRS) 1 (14%vs0%;p=0,00012) and HRS 2(8%vs2%;p=0,005), episodes of hepatic encephalopathy (38%vs15 %;p=0,002), and hyponatremia (38%vs14%; p=0,003) was higher in infected vs non infected patients. Length of hospitalization was longer in infected patients (21,5±15vs10,6±10,5days; p=0,000). In-hospital mortality was increased in patients with bacterial infection vs non-infected (30% vs 4%; p=0.000);main causes were septic shock (5 patients) and HRS (6 patients). 38 patients died within 3 months after admission. Independent predictors of 3-months mortality at multivariate analysis were Child score C (p= 0,00114;O.R.= 4,5;95% CI:1,8-11,1), sepsis (p=0.02;O.R=3,17; 95% CI:1,2-8,44) and protein malnutrition (p= 0,00023;O.R.= 3,17;95% CI:1,2-8,44).
Conclusion: This study shows that bacterial infections are involved in acute deterioration of liver function. Severity of liver disease, protein malnutrition and episodes of sepsis are strong predictors of 3-months mortality after hospitalization.