Tuesday, January 8, 2013

Secondary infections increase mortality in hospitalized patients with cirrhosis

Second infections independently increase mortality in hospitalized patients with cirrhosis, reports the latest issue of Hepatology.


Bacterial infections are an important cause of mortality in cirrhosis, but there is a paucity of multicenter studies.

Dr Jasmohan Bajaj and colleagues from Virginia, USA defined factors predisposing to infection-related mortality in hospitalized patients with cirrhosis.

A prospective, cohort study of patients with cirrhosis with infections was performed at eight North American tertiary-care hepatology centers.

Data were collected on admission vitals, disease severity, including model for endstage liver disease [MELD] and sequential organ failure [SOFA] scores, first infection site, type, and second infection occurrence during hospitalization.

The researchers' outcome was mortality within 30 days.
Secondary infections occurred in 24% of patients

A multivariate logistic regression model predicting mortality was created.

The team evaluated 207 patients.

Most first infections were healthcare-associated, then nosocomial, and community-acquired.

Urinary tract infections, spontaneous bacterial peritonitis, and spontaneous bacteremia formed the majority of the first infections.

The research team observed secondary infections in 24% of patients, and were largely preventable.

Respiratory, including aspiration, urinary, including catheter-related, fungal, and Clostridium difficile infections.

The team found that 24% of patients who died within 30 days had higher admission MELD, lower serum albumin, and second infections but equivalent SOFA scores.

The team observed that the case fatality rate was highest for C. difficile, respiratory, and spontaneous bacteremia, and lowest for spontaneous bacterial peritonitis, and urinary infections.

The researchers noted that model for mortality included admission MELD, heart rate, albumin, and second infection as significant variables.

Dr Bajaj's team concludes, "Potentially preventable second infections are predictors of mortality independent of liver disease severity in this multicenter cirrhosis cohort."

Hepatol 2012: 56(6): 2328–2335
08 January 2013

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