Friday, October 22, 2010

Infections: Exert Heavy Mortality Toll in Cirrhosis

Today HealthDay reported data from the October issue of Gastroenterology,
"Infections increase mortality nearly four-fold; can be seen as additional prognostic factor in cirrhosis infections are associated with a steep increase in one-year mortality risk.
Information From The Cleveland Clinic
"The researchers found that the overall median mortality for patients with infections was 38 percent. At one month, mortality was 30.3 percent, and at one year it was 63 percent. The pooled odds ratio for death among infected patients compared to those without infections was 3.75. The median mortality in studies reporting spontaneous bacterial peritonitis was 43.7 percent, and in studies reporting bacteremia, median mortality was 42.2 percent".
Vasiliki Arvaniti, of the Royal Free Hospital and University College London, and colleagues analyzed data from 178 studies that included 11,987 patients with cirrhosis.
Background & Aims
A staged prognostic model of cirrhosis based on varices, ascites, and bleeding has been proposed. We analyzed data on infections in patients with cirrhosis to determine whether it is also a prognostic factor.
Studies were identified by MEDLINE, EMBASE, COCHRANE, and ISI Web of Science searches (1978–2009); search terms included sepsis, infection, mortality, and cirrhosis. Studies (n = 178) reporting more than 10 patients and mortality data were evaluated (225 cohorts, 11,987 patients). Mortality after 1, 3, and 12 months was compared with severity, site, microbial cause of infection, etiology of cirrhosis, and publication year. Pooled odds ratio of death was compared for infected versus noninfected groups (18 cohorts, 2317 patients).
Overall median mortality of infected patients was 38%: 30.3% at 1 month and 63% at 12 months. Pooled odds ratio for death of infected versus noninfected patients was 3.75 (95% confidence interval, 2.12–4.23). In 101 studies that reported spontaneous bacterial peritonitis (7062 patients), the median mortality was 43.7%: 31.5% at 1 month and 66.2% at 12 months. In 30 studies that reported bacteremia (1437 patients), the median mortality rate was 42.2%. Mortality before 2000 was 47.7% and after 2000 was 32.3% (P = .023); mortality was reduced only at 30 days after spontaneous bacterial peritonitis (49% vs 31.5%; P = .005).
In patients with cirrhosis, infections increase mortality 4-fold; 30% of patients die within 1 month after infection and another 30% die by 1 year. Prospective studies with prolonged follow-up evaluation and to evaluate preventative strategies are needed.

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