Abstract
Cirrhotic patients with bacteremia are at an increased risk of organ failure and mortality. In addition, they can develop serious infection without fever because of their impaired immune response. Our study aimed to investigate the clinical characteristics and outcomes in afebrile bacteremic patients with liver cirrhosis. A single-center, retrospective cohort study was performed on adult patients who visited the emergency department from January 2015 to December 2018. All patients with bacteremia and diagnosis of liver cirrhosis were enrolled and classified as either afebrile or febrile. In total, 104 bacteremic patients with liver cirrhosis (afebrile: 55 patients and, febrile: 49) were included in the study. Compared with the febrile group, patients in the afebrile group showed a significantly higher rate of inappropriate antibiotics administration (43.6% vs. 20.4%, p = 0.01). They were also at an increased risk of 30-day mortality (40% vs. 18.4%, p = 0.02), intensive care unit transfer (38.2% vs. 18.4%, p = 0.03) and endotracheal intubation (27.3% vs. 10.2%, p = 0.03). The afebrile state was also an independent risk factor associated with 30-day mortality in cirrhotic patients with bacteremia. Clinicians should perform a prudent evaluation in cirrhotic patients and carefully monitor for possible signs of serious infection even in the absence of fever.
Highlights
Patients with liver cirrhosis are prone to develop infection because of their cirrhosis-associated immune dysfunction, increased intestinal mucosa permeability and decreased hepatic bacteria filtration[1]
Previous studies regarding bacteremia in cirrhotic patients mainly focused on the severity of cirrhosis, bacteriology, source of infection, and presence of drug-resistant organisms; none of them addressed the issue of body temperature, which could influence the decision of treatment initiation[14,15,16]
Multivariate Cox proportional hazard regression analysis revealed that CLIF-SOFA score and afebrile state were independently associated with increased probabilities of 30-day mortality (Table 4). In this emergency department (ED)-based single-center retrospective study, we investigated the prevalence, clinical characteristics and outcomes in afebrile bacteremic patients with liver cirrhosis
Summary
Patients with liver cirrhosis are prone to develop infection because of their cirrhosis-associated immune dysfunction, increased intestinal mucosa permeability and decreased hepatic bacteria filtration[1]. Clinicians frequently rely on the presence of fever to initiate infection workup[7]; fever is a complex and non-specific host defense response against infection, and might be absent in bacteremic syndrome[8]. Afebrile bacteremic patients often have atypical clinical manifestations, such as lethargy or confusion[9], leading to decreased survival and poorer prognosis[10]. Previous studies regarding bacteremia in cirrhotic patients mainly focused on the severity of cirrhosis, bacteriology, source of infection, and presence of drug-resistant organisms; none of them addressed the issue of body temperature, which could influence the decision of treatment initiation[14,15,16]. Our study aimed to investigate the prevalence, clinical characteristics, and prognosis in afebrile bacteremic patients with liver cirrhosis
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