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. (4th November 2020)

• Record Type: Journal Article
• Authors: Bartoletti, Michele; Baldassarre, Maurizio; Domenicali, Marco; Lewis, Russell E; Giannella, Maddalena; Antognoli, Agnese; Rinaldi, Matteo; Zaccherini, Giacomo; Verucchi, Gabriella; Marconi, Lorenzo; Tamè, Mariarosa; Berardi, Sonia; Napoli, Lucia; Siniscalchi, Antonio; Fabbri, Angela; Biselli, Maurizio; Tufoni, Manuel; Pavarin, Raimondo M; Trevisani, Franco; Viale, Pierluigi; Bernardi, Mauro; Caraceni, Paolo
• Is Part Of: Open forum infectious diseases. Volume 7:Number 11(2020)
• Publication Date: 2020-11-04
• Subjects: cirrhosis -- bacterial and fungal infections -- acute-on-chronic liver failure -- mortality; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa453
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: 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 < .001), QuickSOFA score ≥2 points ( P = .007), and secondary bloodstream ( P = .022) and multidrug-resistant pathogen isolation ( P = .030) were independently associated with ACLF in patients with BFI. Conclusions: This large prospective study indicated that the adverse impact of BFI on long-term survival in decompensated cirrhosis is not universal but is limited to those patients who also develop ACLF. Both disease severity and microbiological factors predispose infected decompensated patients to ACLF. Abstract : 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.