Clinical Characteristics and Prognostic Impact of Bacterial Infection in Hospitalized Patients with Alcoholic Liver Disease.
10.3346/jkms.2015.30.5.598
- Author:
Jin Kyoung PARK
1
;
Chang Hun LEE
;
In Hee KIM
;
Seon Min KIM
;
Ji Won JANG
;
Seong Hun KIM
;
Sang Wook KIM
;
Seung Ok LEE
;
Soo Teik LEE
;
Dae Ghon KIM
Author Information
1. Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea. ihkimmd@jbnu.ac.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Bacterial Infections;
Liver Disease, Alcoholic;
Prognosis
- MeSH:
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
- From:Journal of Korean Medical Science
2015;30(5):598-605
- CountryRepublic of Korea
- Language:English
-
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.
