Response to Congly and Leise

Abstract

To the Editor: We read with interest the concerns raised by Congly et al. (1) about the mortality and antibiotic coverage of infections in our study (2). The majority of patients enrolled in our study had advanced liver disease (>70% were Child's B and C) and severe hepatic encephalopathy (HE) (grade ≥3.80%) (2). We excluded patients with a history, as told by close relatives, of active alcohol intake in the 4 weeks preceding the present episode of HE. We did not perform liver biopsy in these patients, as they were critically ill. Some of our patients even showed symptoms similar to those in patients with acute on chronic liver failure, with sepsis, spontaneous bacterial peritonitis, and variceal bleed being the acute insult on underlying chronic liver disease.