Fungal Infection in Acutely Decompensated Cirrhosis Patients: Value of Model for End-Stage Liver Disease Score.

Autor:	Habib S; Liver Institute PLLC, 5295 E. Knight Dr, Tucson, AZ 85712, USA., Yarlagadda S; Tucson Medical Center, 5301 E Grant Rd, Tucson, AZ 85712, USA., Carreon TA; Liver Institute PLLC, 5295 E. Knight Dr, Tucson, AZ 85712, USA., Schader LM; Liver Institute PLLC, 5295 E. Knight Dr, Tucson, AZ 85712, USA., Hsu CH; Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin Ave., Drachman Hall, PO Box 245210, Tucson, AZ 85724, USA.
Jazyk:	angličtina
Zdroj:	Gastroenterology research [Gastroenterology Res] 2020 Oct; Vol. 13 (5), pp. 199-207. Date of Electronic Publication: 2020 Oct 31.
DOI:	10.14740/gr1255
Abstrakt:	Background: Infection in acute-on-chronic liver failure (ACLF) patients is known to cause higher mortality. The current approach is to culture all patient samples. There are no published data evaluating fungal infections in acutely decompensated patients. In this study, we aim to identify clinical factors predictive of infections within ACLF patients and assess workup compliance within 24 h of hospital admission. Methods: We retrospectively analyzed the charts of 457 ACLF patients seen at the University of Arizona between January 1, 2014 and December 31, 2014. We used logistic regression to identify potential risk indicators for bacterial, fungal, and any infections. In order to proceed to a systemic infection workup, the following parameters were assessed: complete blood count, urinalysis, urine culture, bacterial blood culture, chest X-ray, and ascitic fluid analysis in patients with ascites. Additionally, serological markers were also assessed in patient samples. Systemic inflammatory response syndrome (SIRS) was defined as the presence of two or more of the following criteria: temperature > 38 °C or < 36 °C, heart rate > 90 beats/min, respiratory rate > 20 breaths/min, white blood cell count > 12,000 or < 4,000 cells/mm or > 10% bands. Results: An established infection was observed in 60.61% of ACLF patients. SIRS criteria predicted infections with concordance statistic (C-statistic) of 0.71 (odds ratio (OR) 6.85, 95% confidence interval (CI): 4.33, 10.85) for any infection, 0.63 (OR 2.88, 95% CI: 1.96, 4.23) for bacterial infection, and 0.53 (OR 1.32, 95% CI: 0.59, 2.96) for fungal infection. After including other significant variables (over 10 additional variables), predictive ability improved, C-statistic 0.83 (95% CI: 0.77, 0.90) for any infection and 0.71 (95% CI: 0.65, 0.77) for bacterial infections. The combination of model for end-stage liver disease (MELD) and hemoglobin (Hb) predicted fungal infections with C-statistic 0.74 (95% CI: 0.63, 0.84). Workup within 24 h of admission was obtained in 12% of patients. Conclusions: Fungal infections in ACLF patients results in an increased mortality rate. Elevated MELD and low Hb in combination predict fungal infections. Compliance is very poor to obtain diagnostic workup efficiently, better tools are needed to predict infection upon admission. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright 2020, Habib et al.)
Databáze:	MEDLINE
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