Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort). Issue 2 (28th October 2015)

• Record Type: Journal Article
• Authors: Nahon, Pierre; Lescat, Mathilde; Layese, Richard; Bourcier, Valérie; Talmat, Nabila; Allam, Setty; Marcellin, Patrick; Guyader, Dominique; Pol, Stanislas; Larrey, Dominique; De Lédinghen, Victor; Ouzan, Denis; Zoulim, Fabien; Roulot, Dominique; Tran, Albert; Bronowicki, Jean-Pierre; Zarski, Jean-Pierre; Goria, Odile; Calès, Paul; Péron, Jean-Marie; Alric, Laurent; Bourlière, Marc; Mathurin, Philippe; Blanc, Jean-Frédéric; Abergel, Armand; Serfaty, Lawrence; Mallat, Ariane; Grangé, Jean-Didier; Attali, Pierre; Bacq, Yannick; Wartelle, Claire; Dao, Thông; Benhamou, Yves; Pilette, Christophe; Silvain, Christine; Christidis, Christos; Capron, Dominique; Bernard-Chabert, Brigitte; Hillaire, Sophie; Di Martino, Vincent; Trinchet, Jean-Claude; Moreau, Richard; Roudot-Thoraval, Françoise;
• Other Names: author non-byline.; Kempf Marie author non-byline.; Bert Fréderic author non-byline.; Doloy Alexandra author non-byline.; Poilane Isabelle author non-byline.; Peuchant Olivia author non-byline.; Carbonnelle Etienne author non-byline.; Picard Bertrand author non-byline.; Burucoa Christophe author non-byline.; Cattoir Vincent author non-byline.; Decré Dominique author non-byline.; Degand Nicolas author non-byline.; Dortet Laurent author non-byline.; Kayal Samer author non-byline.; Vernet-Garnier Véronique author non-byline.; Lozniewski Alain author non-byline.; Tuaillon Edouard author non-byline.; Vimont Sophie author non-byline.; Bessède Emilie author non-byline.; Patry Isabelle author non-byline.; Lemaitre Nadine author non-byline.; Pachetii Christine author non-byline.
• Is Part Of: Gut. Volume 66:Issue 2(2017)
• Page Start: 330
• Page End: 341
• Publication Date: 2015-10-28
• Subjects: CIRRHOSIS -- HEPATITIS B -- HEPATITIS C -- BACTERIAL INFECTION; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2015-310275
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis. Design: This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child–Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework. Results: 1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control. Conclusion: BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.