Role of Portal Hypertension in Prediction of Bacterial Infection in Decompensated Cirrhosis

Hasan Sedeek Mahmoud,Shamardan Ezz El-Din S Bazeed

doi:10.4236/ojgas.2014.43016

Abstract

Background: Bacterial infection in cirrhotic patients is a fatal complication. The high incidence of bacterial infections in those patients may be related to several alterations in the defensive mechanisms against infections and increased intestinal permeability with bacterial translocation. Aim: To evaluate the role of portal hypertension (PH) in predicting the occurrence of bacterial infections in decompensated cirrhosis. Patients and Methods: In this retrospective cohort study, 99 patients—56 males and 43 females, with decompensated liver cirrhosis were included. Diagnosis of liver cirrhosis was based on clinical, laboratory and ultrasonographic examinations. Patients were classified according to the presence of bacterial infection into patients with infection—Group 1, and those without infection—Group 2. Laboratory, abdominal US and upper endoscopic data for all patients were collected. Logistic regression analysis was done to detect the independent factors for prediction of bacterial infection. Results: The mean age of patients was 50.5 ± 14.2 years. Bacterial infection was found in 41 patients (41.4%) and no infection in 58 patients (58.6%). Infected patients showed statistically significant higher values in the level of bilirubin, PT and Child-Pugh score (P value = 0.000) and lower values in the level of albumin, total serum protein and PC than those without infection (P value = 0.006, 0.000 and 0.000 respectively). Portal vein diameter (PVD) and splenic diameter (SD) showed statistically significant higher values in infected patients than in those without infection (P value = 0.028 and 0.000 respectively), also infection was more significantly prevalent in patients with varices than those without varices (P value = 0.000). The independent predictors for bacterial infection were: the age, total serum bilirubin, serum albumin, PT, PC, child score, PVD, SD and the presence of varices. Conclusion: Presence of varices (as a complication of PH) is an independent risk factor for the development of bacterial infection in decompensated cirrhotic patients and reduction of PH by any way could decrease this fatal complication.

Highlights

Bacterial infections are a known complication of cirrhosis, with a reported incidence that ranges between 15% and 47% [1] [2].Hospitalized patients with cirrhosis are at increased risk of developing bacterial infections and the most common causes are spontaneous bacterial peritonitis [SBP] and urinary tract infections
The types of infections were defined according to the following standard criteria: Pneumonia was diagnosed in the presence of infiltrates on chest x-ray with concurrent fever, cough, and neutrophilic leukocytosis; spontaneous bacterial peritonitis was diagnosed in the presence of a neutrophil leukocyte count in the ascitic fluid >250 cells/mm3 without any evidence of surgically treatable sources of infections; urinary tract infection was diagnosed when fever and urinary symptoms were associated with bacteriuria, leukocyturia, and positive urine culture; GI tract infection was diagnosed when vomiting, diarrhea, fever, and abdominal pain were associated with neutrophilic leukocytosis and positive stool culture; skin and soft tissue infections were diagnosed when fever and cellulitis were associated with neutrophilic leukocytosis
Patients 99 patients with liver cirrhosis; 56 male (56.6%) and 43 female (43.4%), with their mean age was 50.5 ± 14.2 years were included in the current study

Summary

Introduction

Bacterial infections are a known complication of cirrhosis, with a reported incidence that ranges between 15% and 47% [1] [2].Hospitalized patients with cirrhosis are at increased risk of developing bacterial infections and the most common causes are spontaneous bacterial peritonitis [SBP] and urinary tract infections. Cirrhotic patients who develop an infection have a significantly higher mortality than uninfected patients [4] [5]. Portal vein diameter (PVD) and splenic diameter (SD) showed statistically significant higher values in infected patients than in those without infection (P value = 0.028 and 0.000 respectively), infection was more significantly prevalent in patients with varices than those without varices (P value = 0.000). The independent predictors for bacterial infection were: the age, total serum bilirubin, serum albumin, PT, PC, child score, PVD, SD and the presence of varices. Conclusion: Presence of varices (as a complication of PH) is an independent risk factor for the development of bacterial infection in decompensated cirrhotic patients and reduction of PH by any way could decrease this fatal complication

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