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Second infections independently increase mortality in hospitalized patients With cirrhosis: the north american consortium for the study of end‐stage liver disease (NACSELD) experience
Author(s) -
Bajaj Jasmohan S.,
O'Leary Jacqueline G.,
Reddy K. Rajender,
Wong Florence,
Olson Jody C.,
Subramanian Ram M.,
Brown Geri,
Noble Nicole A.,
Thacker Leroy R.,
Kamath, Patrick S.
Publication year - 2012
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.25947
Subject(s) - medicine , spontaneous bacterial peritonitis , cirrhosis , bacteremia , clostridium difficile , liver disease , gastroenterology , case fatality rate , mortality rate , hepatology , surgery , epidemiology , antibiotics , microbiology and biotechnology , biology
Bacterial infections are an important cause of mortality in cirrhosis, but there is a paucity of multicenter studies. The aim was to define factors predisposing to infection‐related mortality in hospitalized patients with cirrhosis. A prospective, cohort study of patients with cirrhosis with infections was performed at eight North American tertiary‐care hepatology centers. Data were collected on admission vitals, disease severity (model for endstage liver disease [MELD] and sequential organ failure [SOFA] scores), first infection site, type (community‐acquired, healthcare‐associated [HCA] or nosocomial), and second infection occurrence during hospitalization. The outcome was mortality within 30 days. A multivariate logistic regression model predicting mortality was created. 207 patients (55 years, 60% men, MELD 20) were included. Most first infections were HCA (71%), then nosocomial (15%) and community‐acquired (14%). Urinary tract infections (52%), spontaneous bacterial peritonitis (SBP, 23%) and spontaneous bacteremia (21%) formed the majority of the first infections. Second infections were seen in 50 (24%) patients and were largely preventable: respiratory, including aspiration (28%), urinary, including catheter‐related (26%), fungal (14%), and Clostridium difficile (12%) infections. Forty‐nine patients (23.6%) who died within 30 days had higher admission MELD (25 versus 18, P < 0.0001), lower serum albumin (2.4 g/dL versus 2.8 g/dL, P = 0.002), and second infections (49% versus 16%, P < 0.0001) but equivalent SOFA scores (9.2 versus 9.9, P = 0.86). The case fatality rate was highest for C. difficile (40%), respiratory (37.5%), and spontaneous bacteremia (37%), and lowest for SBP (17%) and urinary infections (15%). The model for mortality included admission MELD (odds ratio [OR]: 1.12), heart rate (OR: 1.03) albumin (OR: 0.5), and second infection (OR: 4.42) as significant variables. Conclusion: Potentially preventable second infections are predictors of mortality independent of liver disease severity in this multicenter cirrhosis cohort. (H EPATOLOGY 2012;56:2328–2335)