J Korean Med Sci.  2015 May;30(5):598-605. 10.3346/jkms.2015.30.5.598.

Clinical Characteristics and Prognostic Impact of Bacterial Infection in Hospitalized Patients with Alcoholic Liver Disease

• Park JK
• Lee CH
• Kim IH
• Kim SM
• Jang JW
• Kim SH
• Kim SW
• Lee SO
• Lee ST
• Kim DG

• KMID: 2155473
• DOI: http://doi.org/10.3346/jkms.2015.30.5.598

Abstract

Bacterial infection is an important cause of death in patients with liver cirrhosis. The aim of this study was to investigate the clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease (ALD). We retrospectively analyzed data from 409 patients consecutively admitted to a tertiary referral center with ALD diagnosis. Of a total of 544 admissions, 133 (24.4%) cases presented with bacterial infection, of which 116 were community-acquired whereas 17 were hospital-acquired. The common types of infection were pneumonia (38%), biliary tract infection (17%), soft tissue infection (12%), and spontaneous bacterial peritonitis (9%). Diabetes, serum Na <135 mM/L, albumin <2.5 g/dL, C-reactive protein > or =20 mg/L, systemic inflammatory response syndrome (SIRS) positivity were independently associated with bacterial infection in patients with ALD. Overall 30-day and 90-day mortalities in patients with bacterial infection were significantly (P < 0.001) higher than those without infection (22.3% vs. 5.1% and 32.3% vs. 8.2%, respectively). Furthermore, bacterial infection (HR, 2.2; 95% CI, 1.049-4.579, P = 0.037), SIRS positivity (HR, 2.5; 95% CI, 1.240-4.861, P = 0.010), Maddrey's discriminant function score > or =32 (HR, 2.3; 95% CI, 1.036-5.222, P = 0.041), and hemoglobin <12 g/dL (HR, 2.4; 95% CI, 1.081-5.450, P = 0.032) were independent predictors of short-term mortality. In conclusion, bacterial infection and SIRS positivity predicted short-term prognosis in hospitalized patients with ALD. A thorough evaluation at admission or on clinical deterioration is required to detect possible infection with prompt management.

Keyword

Bacterial Infections; Liver Disease, Alcoholic; Prognosis

MeSH Terms

Adult
Aged
Bacterial Infections/complications/*diagnosis/mortality
C-Reactive Protein/analysis
Candida/isolation & purification
Female
Gram-Negative Bacteria/isolation & purification
Gram-Positive Bacteria/isolation & purification
Hemoglobins/analysis
Hospitalization
Humans
Linear Models
Liver Diseases, Alcoholic/complications/*diagnosis
Male
Middle Aged
Patients
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Serum Albumin/analysis
Sodium/blood
Survival Analysis
Systemic Inflammatory Response Syndrome/complications/diagnosis
Tertiary Care Centers
C-Reactive Protein
Hemoglobins
Serum Albumin
Sodium

Figure

• 

  Fig. 1 Mortalities at 30- and 90-day according to bacterial infections in hospitalized patients with alcoholic liver disease (ALD). *P < 0.01 compared to non-infection group.

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  Fig. 2 Cumulative mortalities up to 90-day according to the prognostic factors including bacterial infection (A), SIRS positive (B), Maddrey's DF score ≥ 32 (C), and hemoglobin level < 12 mg/dL (D). CR, cumulative rate.

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