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Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study
Author(s) -
Gustot Thierry,
Felleiter Peter,
Pickkers Peter,
Sakr Yasser,
Rello Jordi,
Velissaris Dimitrios,
Pierrakos Charalampos,
Taccone Fabio S,
Sevcik Pavel,
Moreno Christophe,
Vincent JeanLouis
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12520
Subject(s) - medicine , cirrhosis , gastroenterology , intensive care unit , septic shock , sepsis , liver transplantation , epidemiology , mortality rate , spontaneous bacterial peritonitis , intensive care , transplantation , intensive care medicine
Background Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit ( ICU ) patients with cirrhosis. Aims We used data from the Extended Prevalence of Infection in Intensive Care ( EPIC ) II 1‐day point‐prevalence study to better define the characteristics of infection in these patients. Methods We compared characteristics, including occurrence and types of infections in non‐cirrhotic and cirrhotic patients who had not undergone liver transplantation. Results The EPIC II database includes 13 796 adult patients from 1265 ICU s: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non‐cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non‐cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram‐positive (56 vs. 47%, P < 0.05) isolates than did infected non‐cirrhotic patients. Methicillin‐resistant Staphylococcus aureus ( MRSA ) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non‐cirrhotic population ( P < 0.001). Severe sepsis and septic shock were associated with higher in‐hospital mortality rates in cirrhotic than in non‐cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). Conclusions Infection is more common in cirrhotic than in non‐cirrhotic ICU patients and more commonly caused by Gram‐positive organisms, including MRSA . Infection in patients with cirrhosis was associated with higher mortality rates than in non‐cirrhotic patients.