Impact of renal dysfunction in cirrhotic patients with bacterial infections other than spontaneous bacterial peritonitis

Abstract

The impact of renal dysfunction has not been well evaluated among cirrhotic patients having bacterial infections other than spontaneous bacterial peritonitis (SBP). We aimed to examine the impact of renal function impairment (RFI) among cirrhotic patients with non-SBP bacterial infections. Data of 7134 cirrhotic patients with non-SBP bacterial infections extracted from the Taiwan National Health Insurance Database, derived from the Taiwan National Health Insurance Program, in 2004 were analyzed. A total of 579 (8.1%) patients had renal dysfunction. Of these, 223 patients had acute renal failure (ARF), and 141 had end-stage renal disease (ESRD) requiring hemodialysis before admission. The overall 30-day, 1-year and 3-year mortalities were 15.8%, 39.3% and 54.5%, respectively. Compared with the non-RFI group, the adjusted hazard ratios (HR) of 30-day mortality for RFI, ARF and ESRD were 3.20 (P < 0.001), 4.81 (P < 0.001) and 1.59 (P = 0.015); the adjusted HR of 1-year mortality for RFI, ARF and ESRD were 2.68 (P < 0.001), 3.50 (P < 0.001) and 1.84 (P < 0.001), and adjusted HR of 3-year mortality for RFI, ARF and ESRD were 2.34 (P < 0.001), 2.97 (P < 0.001) and 1.76 (P < 0.001). The adjusted HR of 30-day, 1-year and 3-year mortalities for the ARF group were 2.98 (P < 0.001), 1.74 (P < 0.001) and 1.58 (P = 0.001) compared with the ESRD group, respectively. This population-based cohort study shows that RFI, especially ARF, is an independent poor prognostic factor in cirrhotic patients with non-SBP bacterial infections.