Predictors and Clinical Profile of Infections in Decompensated Cirrhosis

Abstract

Aim and Background: One of the commonest cause of mortality in cirrhosis liver is infections. Recent studies have demonstrated the role of bacterial translocation. Recent study from our center showed that Gram-negative bacteria is the commonest cause of cellulitis. So the aim of our study was to study various predictors and clinical profile of infections in cirrhosis. Materials and Method: Study was conducted in two phases. First a retrospective observational study analysing electronic data bank in the department of medical gastroenterology from July 2014 to March 2015. A total of 324 cases of decompensated cirrhosis liver with infections were present. In the second phase, 325 controls were selected from the above study period, who had decompensated cirrhosis without infections and case control analysis was done. Results: In our study, 32.3% of the patients had culture positivity. E. coli was the predominant infection (31.2%) followed by Klebsiella. 71.2% of the infections were caused by Gram-negative bacteria. Also the commonest infection was SBP followed by LRTI, cellulitis and UTI in that order. Multivariate analysis showed a MELD score >17, serum creatinine >1.9 mg/dl and serum Na <127. Alcoholic etiology of cirrhosis was an independent risk factor. Alcoholic etiology of cirrhosis, diabetes mellitus and recent antibiotic exposure was an independent risk factor during univariate analysis. Conclusions: Our study showed that Gram-negative infections were the predominant cause of infection in our center. A MELD score >17, serum creatinine >1.9 mg/dl and serum Na <127 were independent risk factor for infection in cirrhosis.