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Prevalence, predictors and impact of bacterial infection in acute on chronic liver failure patients.

Authors
  • Shalimar,1
  • Rout, Gyanranjan2
  • Jadaun, Shekhar S3
  • Ranjan, Gyan4
  • Kedia, Saurabh5
  • Gunjan, Deepak6
  • Nayak, Baibaswata7
  • Acharya, Subrat Kumar8
  • Kumar, Ajay9
  • Kapil, Arti10
  • 1 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 2 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 3 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 4 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 5 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 6 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 7 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 8 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected] , (India)
  • 9 Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, India, India. Electronic address: [email protected] , (India)
  • 10 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India, India. Electronic address: [email protected] , (India)
Type
Published Article
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
Publication Date
Nov 01, 2018
Volume
50
Issue
11
Pages
1225–1231
Identifiers
DOI: 10.1016/j.dld.2018.05.013
PMID: 29910108
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Acute on chronic liver failure (ACLF) is associated with high short term mortality. We aimed to evaluate the prevalence, predictors and impact of bacterial infection in ACLF. Consecutive hospitalized patients with cirrhosis and acute decompensation (AD), from January 2011-March 2017, were included. Predictors of survival and infection were assessed. 572 patients with cirrhosis and AD were classified into 3 groups - no infection (group 1, n = 190, 33.2%), infection at admission/within 48 h (group 2, n = 298, 52.1%) and infection after 48 h (group 3, n = 84, 14.7%). Higher frequency of organ failures - kidney, brain, circulation and respiratory failure - were seen in groups 2 and 3 as compared with group 1 (P < 0.001 for all). Most common site of infection was lungs, followed by spontaneous bacterial peritonitis and urinary tract infection. The frequency of infection increased with higher ACLF grades. Among ACLF patients, on Cox-proportional multivariate analysis, presence of infection was associated with significantly higher mortality [group 2 (HR 2.93; 95%CI, 1.97-4.38, P < 0.001) and group 3 (HR 1.84; 95%CI, 1.16-2.91, P = 0.009)], as compared with group 1. On multivariate logistic regression analysis, advanced hepatic encephalopathy and elevated total leucocyte count were independently associated with development of infection. Infections are common in ACLF, and associated with poor outcome. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

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