Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis?
| Autor: | Mohamed O. Abdel-Malek, Elham Ahmed Hassan, Abeer Sharaf El-Din Abdel Rehim, Asmaa O. Ahmed, Nourhan Mahmoud Abbas |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Cirrhosis Gram-Positive Bacteria Severity of Illness Index Gastroenterology 03 medical and health sciences Liver disease 0302 clinical medicine Recurrence Risk Factors Internal medicine Gram-Negative Bacteria Ascites medicine Humans Hospital Mortality Prospective Studies Hypoalbuminemia Mortality lcsh:RC799-869 Molecular Biology Aged Hyperbilirubinemia Hepatology business.industry Septic shock Mortality rate Smoking Fungi Cellulitis Middle Aged Prognosis medicine.disease Hepatitis C 030220 oncology & carcinogenesis Liver cirrhosis Original Article Female 030211 gastroenterology & hepatology lcsh:Diseases of the digestive system. Gastroenterology medicine.symptom business Complication |
| Zdroj: | Clinical and Molecular Hepatology, Vol 25, Iss 3, Pp 317-325 (2019) Clinical and Molecular Hepatology |
| ISSN: | 2287-2728 |
| Popis: | Background/aims Cellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis. Methods Six hundred twenty consecutive HCV-related cirrhotic patients were evaluated for cellulitis. Demographic and clinical data were evaluated, along with blood and skin cultures. Severity of cirrhosis was assessed using Child-Pugh score. In-hospital mortality was assessed. Results Seventy-seven (12.4%) cirrhotic patients had cellulitis (25 with compensated and 52 with decompensated disease). Smoking and venous insufficiency were risk factors of cellulitis in compensated cirrhosis. Leg edema, ascites, hyperbilrubinemia and hypoalbuminemia were risk factors in decompensated cirrhosis. Gram-positive bacteria (Staphylococcus spp. and Streptococcus pyogenes) were the infective organisms in compensated patients, while gram negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were the predominant organisms in decompensated cirrhosis. Fungi (Candida albicans and Aspergillus niger) were detected in 3 decompensated cases. In-hospital mortality in patients with cellulitis was 27.3%, approaching 100% in decompensated patients with gram-negative cellulitis. Prolonged hospitalization, higher model for end-stage liver disease (MELD)-Na score, septic shock, local complication, and recurrent cellulitis were predictors of mortality. Conclusion Cellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. Cellulitis has a poor prognosis, with mortality rates approaching 100% in decompensated patients with gram-negative cellulitis. Stratifying patients according to severity of cirrhosis is important to identify the proper empirical antibiotic and to decide the proper means of care. |
| Databáze: | OpenAIRE |
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