O9 BACTERIAL INFECTIONS INDUCE BOTH OVERT AND MINIMAL HEPATIC ENCEPHALOPATHY: RESULTS OF A PROSPECTIVE STUDY

Abstract

Background and Aim: Nosocomial infections represent a frequent and severe complication in cirrhotic patients. Predisposing factors for nosocomial infections in this patients have not been clearly identified. The aim of the present study was to assess the risk factors for nosocomial infections in cirrhotic patients. Material and Methods: Consecutive cirrhotic patients admitted at our University Hospital in the last 24 months were enrolled. Diagnosis of infection in the first 48 hours, concomitant HIV infection, immunosuppressive or steroid therapy were considered as exclusion criteria. All possible risk factors for the development of infections (severity of liver disease, variceal bleeding, hyponatremia, presence of TIPS, hospitalization in a room with additional bed, days of hospitalization, invasive procedures) were considered. Results: 238 patients were enrolled (66% males; median age 63 years; median Child score 8, MELD score 14). During the hospitalization, 43 nosocomial infectious episodes were recorded. The main infections were: urinary tract infection (40%), pneumonia (20%), spontaneous bacterial peritonitis (17%). Multidrug resistant bacteria were isolated in 45% of the cases. Patients who developed an infection during the hospitalization were more likely to present a worse liver function (MELD 15±8 vs 12±4; p< 0.01), to bear a TIPS (20% vs 7%; p = 0.05), to be hospitalized in a room with addictive bed (53% vs 19%; p< 0.01) and to undergone a major number of invasive procedures (2.7±2 vs 1.7±1.1; p = 0.01). Moreover, these patients were hospitalized for a longer time (25±17 vs 11±10). At the multivariate analysis, MELD score (p = 0.03; OR 1.1; IC 1.01-1.2), hospitalization in a room with an additional bed (p = 0.004; OR 2.9; IC 1.5-8) and a longer hospital stay (p = 0.001; OR 1.06; IC 1.021.1) were selected as independent factors for the development of nosocomial infections. Conclusions: Severity of liver disease and factors more strictly related to hospitalization, like duration and conditions of hospital stay, are significantly related to the development of nosocomial infections in cirrhotic patients. O9 BACTERIAL INFECTIONS INDUCE BOTH OVERT AND MINIMAL HEPATIC ENCEPHALOPATHY: RESULTS OF A PROSPECTIVE STUDY C. Lucidi, V. Di Gregorio, V. Giannelli, M. Giusto, I. Pentassuglio, C. Pasquale, S. Nardelli, A.F. Attili, O. Riggio, M. Merli. Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Italy