Abstract
Cirrhosis is an immunocompromised state that leads to various infections, with an estimated 30% mortality. Pakistan already has a high morbidity and mortality related to complications of cirrhosis. Where the data on infection among cirrhotics is scanty, this study aimed to determine the frequency, microbiological spectrum and various risk factors of infections in cirrhosis of liver. This is a prospective cohort study conducted at a tertiary care hospital. The microbiological spectrum and frequency of infections was determined in cirrhotics. Various risk factors for infection among cirrhotics were evaluated like upper gastrointestinal bleed, use of proton pump inhibitors, malnutrition and severity of cirrhosis. Out of eleven hundred and forty-one patients with cirrhosis of liver, four hundred and ninety (42.94%) patients had infections. All kinds of infections like peritoneal, respiratory, urinary tract and skin were present in cirrhosis of liver where ascitic fluid infections (AFI) were the commonest i.e. 44.89%. The risk factors for bacterial infections among patients with cirrhosis of liver were upper gastrointestinal bleeding (odd ratio = 4.57, p = 0.0001), use of proton pump inhibitors (odd ratio = 2.57, p = 0.0001), degree of malnutrition (odd ratio = 10.34, p = 0.0001) and severity of cirrhosis (odd ratio = 12.99, p = 0.000). All types of infections occurred with varying frequency in cirrhosis of liver. Upper gastrointestinal bleeding, severity of cirrhosis, use of high dose proton pump inhibitors and severe malnutrition are important risk factors for infections among cirrhotics.
Highlights
Cirrhosis is an immunocompromised state that leads to a variety of infections, which in turn are responsible for an anticipated 30% mortality [1]
There were various kind of infections reported in cirrhotic patients
The frequencies of major group of infections found among cirrhotics are highlighted in (Table 2)
Summary
Cirrhosis is an immunocompromised state that leads to a variety of infections, which in turn are responsible for an anticipated 30% mortality [1]. The poor outcome has been coupled with bacterial infections for painstaking and recurring complications of cirrhosis [2]. Despite of contemporary advancement in the management of cirrhosis and its complications, infections still account a 4-fold increase in mortality [3]. Frequency of infections is higher in decompensated cirrhosis than in compensated disease. Once infection develops, it may ensue other complications like renal failure, encephalopathy and shock which adversely influence the survival. According to some recent prospective data 32% - 34% of cirrhosis either already have bacterial infection at admission or develop one during hospitalization [4]. The higher rate of infections among cirrhotics is in jagged distinction with the 5% - 7% rate of overall infection in general population, endorsing the idea of cirrhosis to be an acquired state of immunodeficiency [1]
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