Abstract
Patients with liver cirrhosis and bacteremia have substantially higher risk of mortality and morbidity. Our study aimed to investigate scoring systems that can predict the mortality risk in patients with cirrhosis and bacteremia. A single-center, retrospective cohort study was performed among adult patients who visited the emergency department from January 2015 to December 2018. All patients diagnosed with liver cirrhosis and bacteremia were enrolled and divided into survivor and nonsurvivor groups for comparison based on their 30-day in-hospital mortality event. The Pitt bacteremia score (PBS), model for end-stage liver disease (MELD) score, Child–Pugh score, and quick sequential Organ Failure Assessment (qSOFA) score were calculated and compared using the area under the receiver operating characteristic (AUROC) curves. A total of 127 patients (survivor: 86; nonsurvivor: 41) were eligible for this study. Compared with the nonsurvivor group, patients in the survivor group had significantly lower MELD score (22 ± 7 vs. 29 ± 5, p < 0.001), lower proportion of high qSOFA (score ≥ 2) (23.3% vs. 51.2%, p < 0.01), and high PBS (score ≥ 4) (7.0% vs. 34.1%, p < 0.001) category. There was also a significantly different distribution in Child–Pugh classification between the two groups (p < 0.01). The survivor group had significantly lower proportion of acute-on-chronic liver failure (27.9% vs. 68.3%, p < 0.001) and fewer number of organ failures (p < 0.001). In comparison of the discriminative ability in mortality risk prediction, PBS (AUROC = 0.83, 95% CI = 0.75–0.90, p < 0.001) and MELD scores (AUROC = 0.78, 95% CI = 0.70–0.86, p < 0.001) revealed a better predictive ability than Child–Pugh (AUROC = 0.69, 95% CI = 0.59–0.70, p < 0.01) and qSOFA scores (AUROC = 0.65, 95% CI = 0.54–0.75, p < 0.01). PBS and MELD scores both demonstrated a superior ability of predicting mortality risk in cirrhotic patients with bacteremia.
Highlights
Liver cirrhosis is the 14th most common cause of death worldwide [1], and cirrhosis-related mortality has continued to increase in the recent decades [2]
Liver cirrhosis is a risk factor associated with death in patients with bacteremia, with a 30-day mortality rate ranging from 39.4–54.8% [5]. e Pitt bacteremia score (PBS) is a widely used scoring system to determine the prognosis and mortality risk for patients with bacteremia [6]; it has not been validated for patients with cirrhosis
More than half (52.8%) of the patients developed cirrhosis attributed to alcohol use; and the majority of them had advanced stage of cirrhosis based on model of end-stage liver disease (MELD) scores and the Child–Pugh classification
Summary
Liver cirrhosis is the 14th most common cause of death worldwide [1], and cirrhosis-related mortality has continued to increase in the recent decades [2]. E incidence of infection in cirrhotic patients increases as their liver function worsens; and mortality risk was four times higher than for those without cirrhosis [1]. Liver cirrhosis is a risk factor associated with death in patients with bacteremia, with a 30-day mortality rate ranging from 39.4–54.8% [5]. E Pitt bacteremia score (PBS) is a widely used scoring system to determine the prognosis and mortality risk for patients with bacteremia [6]; it has not been validated for patients with cirrhosis. While the Child–Pugh score and the model of end-stage liver disease (MELD) score are the most frequently used scoring systems to assess the severity and prognostic significance in patients with end-stage liver disease [7, 8], they have not been validated for cirrhotic patients with bacteremia. We incorporated the quick sequential Organ Failure Assessment (qSOFA)
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