Risk Factors for Bacterial Infections in Cirrhotic Patients

Abstract

Purpose: Cirrhotic patients with bacterial infection have a significantly higher mortality than uninfected cirrhotic patients in many studies, which indicates that bacterial infection is a poor prognostic factor in cirrhotic patients. Thus, it is important to investigate and eliminate the risk factor for bacterial infection in cirrhotic patients. This study was performed to evaluate the risk factors for infections in patients with liver cirrhosis. Methods: The medical records of 674 consecutive admissions with liver cirrhosis hospitalized at the Division of Gastroenterology and Hepatology of Chungang University Yongsan Hospital were retrospectively reviewed between January 2002 and December 2004. The collected data included etiology, severity and complications of cirrhosis, blood test results on admission, isolated pathogenic organism, site of infection and prognosis. Results: Bacterial infections developed in 188 patients (27.9%) and 66 (35.1%) of these developed nosocomial infections. The patients with infection have a higher mortality rate than patients without infection (17.6% vs 5.8%). Gram-negative bacterial strains were the most frequently isolated pathogens, in 62 of the 81 strains isolated. Univariate analysis revealed significant differences between the groups with and without infections with regard to advanced Child-Pugh class, ascites, hepatic encephalopathy, gastrointestinal bleeding, gastroesophageal varices, decompensated liver function, total protein, albumin, total bilirubin, total cholesterol, prothrombin time and activated partial thromboplastin time. Multivariate analysis revealed advanced Child-Pugh class (p = 0.017; odds ratio, 0.566; 95% CI, 0.356–0.902), gastrointestinal bleeding (p = 0.003; odds ratio, 3.973; 95% CI, 1.577–10.011), low serum albumin (p = 0.001; odds ratio, 2.525; 95% CI, 1.440–4.427) and low serum cholesterol (p = 0.003; odds ratio, 1.008; 95% CI, 1.003–1.013) as the independent factors contributing to the development of infections. Conclusions: The present study indicated to need attention should be directed to gram-negative bacterial infections in advanced cirrhotic patients with gastrointestinal bleeding and low serum albumin and cholesterol levels.