Bacterial Infections In Cirrhotic Patients Research Articles

Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors

Background: The association between bacterial infections and proton pump inhibitors (PPIs) has recently been studied with debatable results. Aim: The aim of this study was to investigate the relationship between PPIs and the development of spontaneous bacterial peritonitis (SBP) or other bacterial infections in cirrhotic patients. Materials and Methods: Consecutive cirrhotic patients hospitalized from 2007 through 2012 to Hamad General Hospital–, Doha, Qatar, were enrolled and classified as PPI users or non-users according to PPI consumption in the 90 days prior to hospitalization. Cirrhosis was clinically diagnosed by a combination of physical, biochemical, radiological, and endoscopic findings, or by liver biopsy. Results: A total of 333 patients were included in this study, of whom 171 (51.4%) used PPIs and 162 (48.6%) did not use PPIs. PPI users were significantly older in age (p = 0.001). There was no statistical difference between the 2 groups in sex distribution and etiology of cirrhosis (p > 0.05 for both parameters). PPI users had a significantly higher incidence of overall bacterial infection (38%) than non-PPI users (13.6%), p = 0.0001. Statistical significance is observed specifically for SBP and chest infection (p = 0.0006 and p = 0.01, respectively). In multivariate analysis, older age (> 60 years; OR = 1.246, 95% CI 1.021–08.486; p = 0.02), and PPI use (OR = 2.149, 95% CI 1.124–06.188; p = 0.01) were independent predicting factors for SBP and overall bacterial infection. Conclusion: The present study shows that PPI use, as well as older age (> 60 years), was an independent predicting factor for the development of overall infection and SBP in hospitalized cirrhotic patients. Unless it is indicated, PPI therapy should be avoided in this group of patients, particularly in those older than 60 years of age.

English

This study aimed to investigate the incidence of bacterial infection in chronic hepatitis C virus (HCV) patients with cirrhosis and association between toll-like receptor 4 D299G gene polymorphism and Gram-negative bacterial infections in the patients. 100 HCV cirrhotic patients with ascites and 20 age- and sex-matched healthy subjects as control were included. Conventional culture methods were used to identify the causative organism of infection. Toll-like receptor 4 D299G polymorphism was detected by PCR- RFLP (polymerase chain reaction – restriction fragment length polymorphism). Patients were divided into: Group I: 100 HCV cirrhotic patients with ascites. They were subdivided into: Group I (a): Patients with Toll-like receptor 4 D299G polymorphism, Group I (b): Patients without polymorphism. Group II (control): 20 healthy subjects. This study showed significant higher incidence of infections in cirrhotic patients with Toll-like receptor 4 D299G polymorphism which play a role in the development of bacterial infection in cirrhotic patients that makes down-regulation of TLR4 response one of the immune mechanisms predisposed to Gram negative bacterial infection in cirrhotic patients.   Key words: TLR-4 gene polymorphism, cirrhosis, bacterial infection.&nbsp

Toll-like receptor 4 polymorphisms and bacterial infections in patients with cirrhosis and ascites.

AIMTo assess the relationship between the presence of toll-like receptor 4 (TLR4) polymorphisms and bacterial infections in cirrhotic patients with ascites.METHODSWe prospectively included consecutive patients with cirrhosis and ascites hospitalized during a 6-year period. Patients with human immunodeficiency virus (HIV) infection or any other immunodeficiency, patients with advanced hepatocellular carcinoma (beyond Milan’s criteria) or any other condition determining poor short-term prognosis, and patients with a permanent urinary catheter were excluded. The presence of D299G and/or T399I TLR4 polymorphisms was determined by sequencing and related to the incidence and probability of bacterial infections, other complications of cirrhosis, hepatocellular carcinoma, and mortality during follow-up. A multivariate analysis to identify predictive variables of mortality in the whole series was performed.RESULTSWe included 258 patients: 28 (10.8%) were carriers of D299G and/or T399I TLR4 polymorphisms (polymorphism group) and 230 patients were not (wild-type group). The probability of developing any bacterial infection at one-year follow-up was 78% in the polymorphism group and 69% in the wild-type group (P = 0.54). The one-year probability of presenting infections caused by gram-negative bacilli (51% vs 44%, P = 0.68), infections caused by gram-positive cocci (49% vs 40%, P = 0.53), and spontaneous bacterial peritonitis (29% vs 34%, respectively, P = 0.99) did not differ between the two groups. The one-year probability of transplant-free survival was 55% in the polymorphism group and 66% in the wild-type group (P = 0.15). Multivariate analysis confirmed that age, Child-Pugh score, active alcohol intake, previous hepatic encephalopathy, hepatocellular carcinoma and serum creatinine were associated with a higher risk of death during follow-up.CONCLUSIONGenetic polymorphisms D299G and/or T399I of TLR4 do not seem to play a relevant role in the predisposition of cirrhotic patients with ascites to bacterial infections.

Presepsin levels in cirrhotic patients with bacterial infections and/or portal hypertension-related bleeding, presenting with or without acute kidney injury.

BackgroundBacterial infections in cirrhotic patients remain a challenge. Presepsin has been proposed as a valuable sepsis biomarker. We aimed to assess plasma presepsin levels in uncomplicated cirrhotic patients and to correlate them with liver disease severity and complicating events, defined as documented bacterial infection with or without concomitant portal hypertension-related bleeding, or bleeding without documented bacterial infection, with or without acute kidney injury.MethodsWe prospectively evaluated the presepsin levels of 108 consecutive uncomplicated cirrhotic patients with compensated (55, 50.9%) or decompensated (53, 49.1%) cirrhosis. During the follow up, 20 patients were reevaluated for a complicating event.ResultsMean baseline presepsin levels of the entire population were 440.4 pg/mL. Patients with decompensated cirrhosis exhibited significantly higher baseline levels than patients with compensated cirrhosis (599.1±492.2 vs. 287.5±130.5 pg/mL, P<0.001). In complicated cirrhotic patients, admission levels were remarkably higher than baseline (1438.0±1247.2 vs. 725.3±602.8 pg/mL, P<0.001), especially in those who developed acute kidney injury compared to those who did not (1827.3±1118.8 vs. 1048.7±1302.1 pg/mL, P<0.05). Baseline presepsin levels, using a cutoff of 607.5 pg/mL, could predict liver disease-related 3-month mortality with 77.8% sensitivity and 86.9% specificity: area under the receiver operating characteristic curve 0.825; 95% confidence interval 0.684-0.967; P<0.01.ConclusionsPlasma presepsin levels are elevated in uncomplicated cirrhotic patients, especially in those with advanced liver disease, and rise further in those complicated by an event. Baseline presepsin levels in cirrhotic patients could be used as an additional marker, along with the model for end-stage liver disease score, to predict short-term outcomes.

Elective endoscopic variceal ligation is not a risk factor for bacterial infection in patients with liver cirrhosis

BackgroundPatients with cirrhosis are at high risk of bacterial infections. Invasive procedures are generally believed to increase this susceptibility. AimsWe investigated the incidence of bacterial infections in cirrhotic patients undergoing elective endoscopic variceal ligation (EVL). MethodsWe enrolled 60 consecutive cirrhotic patients who underwent a total number of 112 elective EVL procedures. One to seven bands were applied at each session until variceal eradication. Markers of inflammation/infection and blood cultures were obtained before and 24 h after EVL. ResultsAetiology of liver disease was metabolic in 27 (45%), viral in 21 (35%), alcoholic in 12 (20%) patients. Child–Pugh class A/B/C distribution was 29/26/5, respectively, 23 (38%) patients had ascites and 15 (25%) had hepatocellular carcinoma. Blood cultures were negative in all samples before EVL, whereas 3/112 (2.7%) cultures tested positive after endoscopy. Streptococcus mitis and Staphylococcus epidermidis were isolated in 1 and 2 cases, respectively. None of these three patients developed any features of clinically relevant infection, suggesting that the positive cultures were an expression of a transient bacteraemia with no clinical sequelae. ConclusionsBacterial infection is an uncommon occurrence after elective EVL in cirrhotic patients, and antibiotic prophylaxis is not necessary in this clinical setting.

C-Reactive Protein and Resistin Detect Bacterial Infections in Liver Cirrhosis

Introduction: Bacterial infection usually has poor outcome, but often full of diagnostic difficulties in cirrhotic patients. The role of clinical parameters such as systemic inflammatory response syndrome, leukocyte count, neutrophil count, and other markers remains unclear in liver cirrhosis patients. The aim of this study was to evaluate the usefulness of inflammatory markers and determined which markers were best for the diagnosis of infection in decompensated cirrhotic patients. Methods: This was a diagnostic study consisted of 80 cirrhotic patients admitted to Sanglah general hospital, Denpasar from August 2014 until July 2015. Prospective study was designed. Markers of infection consist of leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) and resistin were measured. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: Bacterial infections were noted in twenty patients (25%) and spontaneous bacterial peritonitis (SBP) was the most common infections occurred. NLR, CRP, and resistin were higher in bacterial infections group (p < 0.05). Multiple logistic regression analyses showed that CRP and resistin were predictive factor for occurrence of bacterial infections (p < 0.05). For the diagnosis of infection, baseline CRP - using a 11.65 mg/L cut-off value - and resistin - using a 13 ng/mL cut-off value - generated area under the receiver operating characteristic (ROC) curve of 0.796 and 0.787, respectively. The sensitivity, specificity, PPV, and NPV for CRP were 90%, 73%, 52.9%, and 95.7%, respectively. For resistin, the sensitivity, specificity, PPV, and NPV were 90%, 59%, 41.9%, and 94.6% respectively. Conclusion: In the present study, CRP level of 11.65 mg/L or resistin 13 ng/mL seem adequate in rule out infections. Pieri et al in 2014 found out that CRP is still reliable in prediction of bacterial infection in cirrhosis. Johansson et al stated that resistin increase in noncirrhotic patients with severe sepsis. Currently there are no data on resistin levels in cirrhotic patients with bacterial infections. This study showed that resistin may have role in bacterial infections. In conclusion, resistin and CRP showed good accuracy as screening tests in diagnosing bacterial infection in cirrhotic patients. In the future, these modalities may aid clinician in predicting which patient more likely to have infections.Figure: Distribution of the serum concentration of resistin (A), C-reactive protein (CRP) (B), and neutrophil-lymphocyte ratio (NLR) (C) in liver cirrhosis patients with or without infections.Figure: ROC curves of CRP and resistin for the diagnosis of infection at admission.Table: Table. Diagnostic accuracy of C-reactive protein and resistin in diagnosing infection in liver cirrhosis.

Bacterial infections in patients with liver cirrhosis: clinical characteristics and the role of C-reactive protein.

Background:The diagnosis of bacterial infection in cirrhotic patients may be difficult, because of the absence of classical signs such as fever and raised white blood cell count. The role of C-reactive protein (CRP) in this context has not been clearly defined.Methods:Clinical and laboratory characteristics of 210 consecutive cirrhotic patients with (n=100) or without (n=110) bacterial infection were compared with a control group of non-cirrhotic patients with infection (n=106).Results:Significantly fewer patients with cirrhosis had a body temperature ≥37°C when presenting with bacterial infection (56% cirrhotic vs. 85.5% non-cirrhotic patients, P=0.01). Mean leukocyte count was 6.92 × 103/mm3 in patients with cirrhosis and infection, 5.75 × 103/mm3 (P=0.02) in cirrhotic patients without infection, and 11.28 × 103/mm3 in non-cirrhotic patients with infection (P<0.001). Multivariate analysis revealed that CRP level and model for end-stage liver disease score were significantly associated with the presence of infection in patients with cirrhosis. A cutoff level of CRP>10 mg/L indicated the presence of infection with a sensitivity of 68%, a specificity of 84.5% and an area under the receiver operating characteristic curve of 0.8197. CRP cutoff level differed according to the severity of the liver disease: Child-Pugh score (CPS) A: 21.3 mg/L, B: 17 mg/L, and C: 5.78 mg/L.Conclusions:CRP at admission could help diagnose infection in cirrhotic patients. Since the severity of liver disease seems to affect the CRP values, lower CRP levels might indicate infection. Clinical suspicion is necessary to avoid delay in diagnosis and initiate antibiotic treatment.

Serum interleukin-6 in the diagnosis of bacterial infection in cirrhotic patients: A meta-analysis.

Background:The diagnostic accuracy of interleukin-6 (IL-6) in predicting bacterial infection in cirrhotic patients remains unclear. The aim of this meta-analysis is to explore the potential diagnostic value of IL-6 in cirrhotic patients.Methods:We systematically searched PubMed, Embase (via OvidSP), Web of Science, the Cochrane Library, and Scopus for studies published from inception to October 2015. Studies were enrolled if they included assessment of the accuracy of IL-6 in the diagnosis of bacterial infection in cirrhotic patients and provided sufficient data to construct a 2 × 2 contingency table.Results:Totally, 535 studies were searched in the initial database and finally 6 studies involving 741 patients were included for the final analysis. The pooled sensitivity, specificity and diagnostic odds ratio were 0.85 (95% confidence interval [CI], 0.64–0.94), 0.91 (95% CI, 0.80–0.96) and 52.89 (95% CI, 15.21–183.86), respectively. The pooled positive likelihood ratio was 8.99 (95% CI, 4.13–19.55) and the pooled negative likelihood ratio was 0.17 (95% CI, 0.07–0.43). The area under the receiver operating characteristic curve was 0.94 (95% CI, 0.92–0.96).Conclusion:This meta-analysis suggests IL-6 has a high diagnostic value for the differentiation of bacterial infection in patients with cirrhosis.

Label-free bimodal waveguide immunosensor for rapid diagnosis of bacterial infections in cirrhotic patients

Spontaneous bacterial peritonitis is an acute bacterial infection of ascitic fluid; it has a high incidence in cirrhotic patients and it is associated with high mortality. In such a situation, early diagnosis and treatment is crucial for the survival of the patient. However, bacterial analysis in ascitic fluid is currently based on culture methods, which are time-consuming and laborious. We report here the application of a photonic interferometer biosensor based on a bimodal waveguide (BiMW) for the rapid and label-free detection of bacteria directly in ascitic fluid. The device consists of a straight waveguide in which two modes of the same polarization interfere while interacting with the external medium through their evanescent fields. A bimolecular event occurring on the sensor area of the device (e.g. capturing bacteria) will differently affect each light mode, inducing a variation in the phase of the light exiting at the output of the waveguide. In this work, we demonstrate the quantitative detection of Bacillus cereus in buffer medium and Escherichia coli in undiluted ascitic fluid from cirrhotic patients. In the case of Bacillus cereus detection, the device was able to specifically detect bacteria at relevant concentrations in 12.5min and in the case of Escherichia coli detection, the analysis time was 25min. Extrapolation of the data demonstrated that the detection limits of the biosensor could reach few bacteria per milliliter. Based on the results obtained, we consider that the BiMW biosensor is positioned as a promising new clinical tool for user-friendly, cost-effective and real-time microbiological analysis.

Presence of multiple bacterial markers in clinical samples might be useful for presumptive diagnosis of infection in cirrhotic patients with culture-negative reports.

Bacterial infections in cirrhotic patients with ascites are associated with a severe prognosis and an increased risk of death. The microbiological standard tests for the diagnosis of suspected infection, based on culture test of blood and ascitic fluid, are, in many cases (30-40%), negative, even when patients show symptoms of infection. A multiple culture-independent protocol was applied and evaluated as a diagnostic and prognostic tool for the detection of bacterial infection in cirrhotic patients. Sixty-four culture-negative samples obtained from 34 cirrhotic patients, with PMN < 250 cells/μl of ascitic fluid, were screened for the presence of bacterial DNA, endotoxin, peptidoglycan/β-glucan and microscopically visible bacterial cells. Correlations between the presence of multiple markers and various clinical and laboratory parameters were evaluated. Bacterial DNA was detected in 23 samples collected from 16 patients; a large part of these samples also showed the presence of other bacterial markers, which was associated with a worsening of liver functionality, a higher incidence of infections during the follow-up and a higher mortality rate in our cohort of cirrhotic patients. We believe that the detection of additional bacterial markers in bacterial DNA-positive clinical samples makes the bacterial presence and its clinical significance more realistic and might be useful as early markers of an ongoing bacterial infection and in establishing a clinical prognosis.

Skin and soft tissue bacterial infections in cirrhotic patients with edema

Objective: The aim of this study was to determine the type, risk factors, and the causative organism of bacterial skin infections in cirrhotic patients with edema. Background: Bacterial infections are often associated with significant morbidity and mortality in cirrhosis. The common practice of outdoor barefoot walking and the associated risk of trauma may predispose cirrhotic patients to skin infection. Patients and methods: This study was conducted on 150 patients, of whom 35 cirrhotic patients served as the control group. Data, including the type, the site, risk factors, and the culture results of the skin or soft tissue infection present, were collected. Results: A unique criterion of this study was that in all the study participants in the cirrhotic group the infection was due to posthepatitic cirrhosis (hepatitis C virus, hepatitis B virus, or combined infection). History or evidence of trauma, uncontrolled diabetes, massive lower-limb edema, and a high BMI are major risk factors for developing skin or soft tissue infection. Cellulitis represents the most common type of infection, affecting mainly the lower limbs. Gram-negative organisms are the causative organisms in cirrhotic patients (17%), mainly Escherichia coli in 13% of the cases. Conclusion: Gram-negative bacteria may cause bullous cellulitis in patients with cirrhosis. Trauma, diabetes mellitus, and massive lower-limb edema are major risk factors for skin and soft tissue infections in cirrhotic patients.

Sa1014 Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

Sa1014 Bacterial Infections in Cirrhotic Patients in a Tertiary Care Hospital

Mechanisms of susceptibility to bacterial infections in cirrhotic patients

Mechanisms of susceptibility to bacterial infections in cirrhotic patients

Novel insights in preventing Gram-negative bacterial infection in cirrhotic patients: review on the effects of GM-CSF in maintaining homeostasis of the immune system.

Cirrhotic patients with dysfunctional and/or low numbers of leukocytes are often infected with bacteria, especially Gram-negative bacteria, which is characterized by producing lipopolysaccharide (LPS). Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a pleiotropic cytokine that influences the production, maturation, function, and survival of various immune cells. In this paper, we reviewed not only Toll-like receptors 4 (TLR4) signaling pathway and its immunological effect, but also the specific stimulating function and autocrine performance of GM-CSF on hematopoietic cells, as well as the recent discovery of innate response activator-B cells in protection against microbial sepsis and the direct LPS-TLR4 signaling on hematopoiesis. Thus we concluded that GM-CSF might play important roles in preventing Gram-negative bacterial infections in cirrhotic patients through maintaining immune system functions and homeostasis.

Interleukin-1 receptor antagonist correlates with hepatic venous pressure gradient and predicts occurrence of overall complications and bacterial infections in patients with cirrhosis.

The plasma levels of interleukin (IL)-1α, IL-1β and IL-1 receptor antagonist (IL-1Ra) are increased in cirrhotic patients. We aimed to investigate whether these cytokines correlate with hepatic venous pressure gradient (HVPG), the severity of liver cirrhosis and complications of cirrhosis. Sixty-three cirrhotic patients that underwent hemodynamic studies in Taipei Veterans General hospital were enrolled retrospectively. Plasma levels of IL-1α, IL-1β, IL-1Ra and endotoxin were assessed by enzyme-linked immunosorbent assay. Plasma obtained from 11 healthy subjects served as normal controls. Plasma levels of IL-1α, IL-1β and IL-1Ra were increased in cirrhotic patients compared with controls. IL-1Ra levels significantly correlated with plasma endotoxin levels, Child-Pugh scores, Model of End-Stage Liver Disease (MELD) scores and HVPG. On multivariate analysis, higher IL-1Ra levels (≥760 pg/mL) predicted the occurrence of portal hypertension-related complications and the development of bacterial infections independently of the MELD scores and portal pressure. Furthermore, higher IL-1Ra levels also predicted the survival in patients without hepatocellular carcinoma. The plasma IL-1Ra level correlates with HVPG. Additionally, it may predict the occurrence of portal hypertension-related complications and bacterial infections in cirrhotic patients and the survival in patients without hepatocellular carcinoma.

A multicenter prospective study of infections related morbidity and mortality in cirrhosis of liver.

Infections are a common and serious complication among patients with cirrhosis. We assessed the epidemiology, risk factors, and clinical consequences of bacterial infections in cirrhotic patients. In this multicenter prospective study, all patients with cirrhosis of liver with different infections were analyzed. Infections were classified as community-acquired (CA), healthcare-associated (HCA), or hospital-acquired (HA). Site of infection and characteristics of bacteria were recorded; effect on liver function and 30-day survival were evaluated. One hundred and six out of 420 (25%) patients with cirrhosis of liver had infection. Infection rate among indoor patients was 37.5% (92/245) and among outdoor patients was 8% (14/175). Out of 106 patients, CA, HCA, and HA were seen in 19.8%, 50%, and 30.2%, respectively. Spontaneous bacterial peritonitis (31.1%), urinary tract infections (22.6%), and pneumonia and cellulitis (11.3% each) were common infections. Gram-negative bacteria (54%) were more common than Gram-positive cocci (46%). Multidrug resistant (MDR) organisms were seen in 41.7% of patients. Most of the MDR organisms were seen in HCA and HA patients. The degree of liver impairment was significantly more severe in patients with infection. Independent predictor of infection was high Child-Turcott-Pugh (CTP) class (p = 0.006, Child B vs. A (odds ratio (OR) 3.04 95% CI = 1.63 to 5.68) and Child C vs. A (OR 4.17 95% CI = 2.12 to 8.19). Overall in-hospital mortality was 7.6%. Patients with infection had increased mortality at 30-day follow up compared to those without infection (23.5% vs. 2.2%; p<0.001). Infections are one of the important causes of morbidity and mortality in patients with cirrhosis of liver. The most frequent infections are HCA and HA. Infection predisposes to deterioration of liver function and increases mortality. Cirrhotic patients should be monitored closely for infections especially those with Child class B and C.

Low Levels of 25-Hydroxy Vitamin D are Independently Associated with the Risk of Bacterial Infection in Cirrhotic Patients.

OBJECTIVES:Low levels of vitamin D are associated with a higher mortality in cirrhotic patients, but the role of this deficiency is still unknown. The purpose of this study was to assess the levels of vitamin D in cirrhotic patients with and without bacterial infection.METHODS:25-hydroxy (25-OH) vitamin D was assessed by immunoassay in 88 patients hospitalized in our hepatology unit.RESULTS:The causes of cirrhosis were mainly alcohol (70%), hepatitis C (10%), or both (9%). Infections (n=38) mainly included bacteriemia (21%), urinary tract infections (24%), and spontaneous bacterial peritonitis (29%). A severe deficiency in vitamin D (<10 ng/ml) was observed in 56.8% of patients. Infections were more frequent in patients with a severe deficiency compared with the others (54 vs. 29%, P=0.02). A severe deficiency in vitamin D was a predictive factor of infection (odds ratio=5.44 (1.35–21.97), P=0.017) independently of the Child–Pugh score (odds ratio=2.09 (1.47–2.97) P=0.00004) and the C-reactive protein level (odds ratio=1.03 (1.002–1.052), P=0.03) in a logistic regression also including the alanine amino transferase (not significant). By a Cox regression analysis, only the presence of an infection was significantly associated with mortality (relative risk=3.24 (1.20–8.76), P=0.02) in a model also associating the Child–Pugh score (not significant) and the presence of a severe deficiency in vitamin D (not significant).CONCLUSIONS:Low levels of 25-OH vitamin D were independently associated with bacterial infections in cirrhotic patients. The impact of 25-OH vitamin D supplementation on the infection rate and death of cirrhotic patients should be assessed in randomized trials.

The effect of bacterial infections in cirrhotic patients with esophageal variceal bleeding

Background. Cirrhotic patients are prone to having bacterial infections due to impaired innate immunity. This nationwide population-based study aimed to identify the effect of bacterial infections on the mortality of the cirrhotic patients with esophageal variceal bleeding (EVB).Material and methods. The Taiwan National Health Insurance Database was used to collect data about the cirrhotic patients receiving endoscopic procedures for EVB between January 1, 2004 and December 31, 2004. The enrolled patients were followed up individually for one year to identify their 6-week and 1-year mortalities.Results. Of the 2,053 cirrhotic patients with EVB, 318 (15.5 %) were diagnosed with bacterial infections. Compared to non-infection group, the adjusted hazard rations (HRs) of bacterial infection for 6-week and 1-year mortalities were 2.69 (2.06-3.52) and 1.89 (1.56-2.28), respectively. Compared to non-infection group, the HRs of pneumonia, spontaneous bacterial peritonitis, urinary tract infection, and sepsis without specific focus (SWSF) were 3.54, 1.91, 1.04, and 3.95 for 6-week mortality, and 3.18, 1.52, 1.15, and 2.23 for 1-year mortality of cirrhotic patients with EVB.Conclusions. In cirrhotic patients with EVB, bacterial infections increase 2.7 folds of 6-week mortality and 1.9 folds of 1-year mortality. Of all infections, pneumonia and SWSF contributed higher risks for mortality.

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

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.

Infeções bacterianas no doente com cirrose hepática

Bacterial infections are a frequent complication on hepatic cirrhosis, particularly in hospitalized patients.In this article we review the prevalence, risk factors and pathogenesis of bacterial infections in cirrhotic patients, focusing on the mechanisms of bacterial translocation.The most common bacterial infections in cirrhotic patients are the commonly called “spontaneous” infections, namely spontaneous bacterial peritonitis, spontaneous bacterial pleural empyema and spontaneous bacteraemia.At the end of this article we make a brief reference to the prevention strategies for infection in cirrhosis, namely prophylaxis of spontaneous bacterial peritonitis and prevention of specific viral or bacterial infections through vaccination.