20. Episodes of bacterial infections in patients with acute-on-chronic liver failure (ACLF)

Abstract

Background and Aims: ACLF is a state of immune paralysis;leading to high risk of infections. Aim of the study was to assess the episodes of bacterial infections in a homogenous group of alcohol related cirrhosis presenting as ACLF. Methods: Patients of ACLF were included prospectively after informed consent and divided into i-ACLF (infections as acute event) and h-ACLF (hepatic insults like alcoholic hepatitis, DILI, etc. as acute event). Patients were evaluated for episodes of bacterial infections occurring before and after hospitalization. Results: Of 113 patients included in the study (all males,mean age 45 ± 9 years) 36 (32%) had i-ACLF and 77 (68%) had h-ACLF. Patients with i-ACLF who presented with first episode of community acquired infections, 22 (61%) had evidence of spontaneous bacterial peritonitis (SBP), 9 (25%) had skin and soft tissue infection (SSTI), 3 (8%) had urinary tract infection (UTI) and 1 (3%) each had spontaneous bacterial empyema (SBE) and liver abscess. After hospitalization, 27 (75%) of these patients with i-ACLF developed episode of second infection- pneumonia (18, 67%), SBP (5,19%), bacteremia (2, 7%), SBE (1, 4%) and C. difficile diarrhea (1, 4%). Fifty two (68% of 77) patients with h-ACLF who did not have evidence of infection at admission developed first episode of infection in the hospital-SBP (28,54%), UTI (8,15%), bacteremia (6,12%) and SSTI (2,4%). Twenty seven (35%) patients with h-ACLF developed a second episode of in-hospital infection-pneumonia (15, 56%), SBP (4, 15%), bacteremia (4, 15%), UTI (3, 11%) and SBE (1, 4%). Mortality in patients with any episode of infection (52/88–59%) was higher than without (2/25–8%) (p < 0.001). Occurrence of second infection was an independent predictor of in- hospital mortality (OR 5.3). Conclusions: Patients with ACLF have multiple episodes of bacterial infections. SBP is the most common first infection in patients with ACLF and pneumonia is the most common second infection. The authors have none to declare.