Prognostic Role of Bacterial and Fungal Infections in Patients With Liver Cirrhosis With and Without Acute-on-Chronic Liver Failure: A Prospective 2-Center Study
| Autor: | Lorenzo Marconi, Maurizio Biselli, Antonio Siniscalchi, Marco Domenicali, Franco Trevisani, Paolo Caraceni, Maddalena Giannella, Pierluigi Viale, Gabriella Verucchi, Lucia Napoli, Angela Fabbri, Maurizio Baldassarre, Giacomo Zaccherini, Agnese Antognoli, Raimondo Maria Pavarin, Russell E. Lewis, Michele Bartoletti, Mariarosa Tamè, Matteo Rinaldi, Manuel Tufoni, Sonia Berardi, Mauro Bernardi |
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| Přispěvatelé: | Bartoletti M., Baldassarre M., Domenicali M., Lewis R.E., Giannella M., Antognoli A., Rinaldi M., Zaccherini G., Verucchi G., Marconi L., Tame M., Berardi S., Napoli L., Siniscalchi A., Fabbri A., Biselli M., Tufoni M., Pavarin R.M., Trevisani F., Viale P., Bernardi M., Caraceni P. |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cirrhosis bacterial and fungal infections Bacterial and fungal infection Logistic regression Major Articles 03 medical and health sciences Liver disease 0302 clinical medicine Internal medicine medicine Decompensation Mortality Prospective cohort study Cirrhosi business.industry cirrhosis Mortality rate medicine.disease Comorbidity acute-on-chronic liver failure mortality Acute-on-chronic liver failure AcademicSubjects/MED00290 Infectious Diseases Oncology 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Observational study business |
| Zdroj: | Open Forum Infectious Diseases |
| ISSN: | 2328-8957 |
| DOI: | 10.1093/ofid/ofaa453 |
| Popis: | Background Bacterial and fungal infections (BFIs) are frequent in patients with cirrhosis and often trigger acute-on-chronic liver failure (ACLF). This prospective observational study aims to describe the interactions between BFI and ACLF in terms of mortality and related risk factors. Methods We performed a 2-center prospective observational study enrolling hospitalized patients with cirrhosis admitted for acute decompensation. Data were recorded at admission and during hospitalization. Survival was recorded up to 1 year. Results Among the 516 patients enrolled, 108 (21%) were infected at admission, while an additional 61 patients (12%) developed an infection during hospital stay. In the absence of ACLF, the 1-year mortality rate of patients with BFI did not differ from that of patients without BFI (33% vs 31%; P = .553). In contrast, those with ACLF triggered or complicated by BFI had a significantly higher mortality rate than those who remained free from BFI (75% vs 54%; P = .011). Competing risk analysis showed that the negative impact of ACLF-related BFI on long-term prognosis was independent from Model for End-stage Liver Disease (MELD) incorporating serum sodium concentration score, comorbidity, and basal C-reactive protein level. Finally, multivariable logistic regression showed that higher MELD score (P The adverse prognosis of bacterial or fungal infections in patients with decompensated cirrhosis is linked to the development of acute-on-chronic liver failure. Severity, type and microbiological features of infections are main predictors of the development of acute-on-chronic liver failure. |
| Databáze: | OpenAIRE |
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