Mortality, sepsis, and organ failure in hospitalized patients with cirrhosis vary by type of infection

Abstract

Background and Aim: Infection is associated with substantial morbidity and mortality in cirrhosis, but presumably, not all infections carry the same risk of mortality. We compared outcomes of different sites of infection in a nationally representative sample of inpatients with cirrhosis. Methods: We queried the Nationwide Readmissions Database for patients with cirrhosis from 2011 to 2014. Cirrhosis and infection diagnoses were identified by previously used algorithms of ICD-9 codes. The following infections were compared: urinary tract infection (UTI), pneumonia, cellulitis, spontaneous bacterial peritonitis (SBP), and Clostridium difficile infection (CDI). The primary outcome was inpatient mortality. Secondary outcomes included sepsis, any organ failure, multiple organ failures, and 30-day readmission. Outcomes were analyzed using logistic regression and included a priori covariates. Results: A total of 1 798 830 weighted index admissions were identified. Infection was present in 29.2% overall-including UTI (13.7%), pneumonia (8.9%), cellulitis (5.2%), CDI (2.8%), and SBP (2.0%). Mortality was significantly higher in pneumonia (19.6%), SBP (18.6%), and CDI (17.4%) compared with cellulitis (7.6%) and UTI (11.8%). Sepsis, any, and multiple organ failures were most commonly seen in pneumonia, SBP, and CDI. Multivariable analysis demonstrated that pneumonia had the highest associated mortality (odds ratio [OR] 2.73, confidence interval [CI] 2.68-2.80) and multiple organ failures (OR 3.59,. Significantly increased 30-day readmission was seen only with SBP (24.9%). Conclusions: Outcomes of inpatients with cirrhosis vary significantly depending on the type of infection. The severity and epidemiology of infection in cirrhosis appears to be shifting with pneumonia, not SBP, having the highest prevalence of multiple organ failures and inpatient mortality.

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

“…Pneumonia, SBP, and CDI had notably higher mortality than cellulitis and UTI, and sepsis and organ failure were also more common. Pneumonia had the highest mortality in the multivariate regression analysis (OR 2.73, 95%CI 2.68-2.80) and caused multiple organ failure (OR 3.59, 95%CI 3.50-3.68)[ 108 ]. The prevalence of CDI in cirrhosis has shown an increasing trend at approximately 2.7% in 2014, while the mortality of CDI is on the decline, and in local hospitals, the incidence of CDI ranges from 4.9% to 18.8%[ 109 ].…”

Clostridioides difficile Infection in Liver Cirrhosis: A Concise Review

“…In a study conducted in an extensive commercial database in the US, the prevalence of CDI in cirrhosis was 134.93 per 100,000 of 133,400 patients diagnosed with cirrhosis between 2018–2021 [ 30 ]. Nationwide Readmissions Database (NRD) in the US revealed that the prevalence of CDI in patients with cirrhosis was 2.8% from 2011 to 2014, with higher inpatient mortality compared with cellulitis and urinary tract infections (UTI) (17.6% vs. 7.6%, 11.8%), respectively, and the presence of sepsis and organ failure was also most common in CDI [ 31 ]. Another study using the National Inpatient Sample (NIS) [ 32 ], which investigated trends in CDI hospitalizations for end-stage liver disease (ESLD) from 2005 to 2014, found that the prevalence of CDI among inpatients with decompensated cirrhosis increased approximately twofold from 1.3% in 2005 to 2.7% in 2014, with an annual rate of increase of 7.8%.…”

“…Therefore, understanding and predicting the prognosis of this population is essential to mitigate the risk of undesirable outcomes. Extensive publications have reported increased mortality of CDI in patients with cirrhosis [ 22 , 23 , 31 , 33 , 34 , 36 , 39 , 44 , 47 , 48 , 59 ]. However, one study has not established the impact of CDI development on mortality in patients with cirrhosis and SBP receiving norfloxacin as secondary prophylaxis [ 37 ].…”

“…Yet another study indicated that CDI was associated with increased 30-day mortality but not with increased overall mortality [ 48 ]. Alongside increased mortality, CDI could potentially carry an additional risk of complications, including sepsis [ 31 ], organ failure [ 31 ], portal vein thrombosis [ 62 ], and readmission [ 21 ]. Caution should be taken, as readmission is associated with increased severity of cirrhosis and mortality [ 21 , 40 ].…”

Features of the Immune Status in Patients With Liver Cirrhosis of the of Various Etiologies

“…Цирроз печени (ЦП) является одной из острых проблем здравоохранения в связи с большой распространенностью во всем мире, развитием различных осложнений и значительным снижением качества жизни больных [1]. К числу наиболее часто встречающихся осложнений при ЦП относятся инфекции (пневмония, инфекции мочевыводящих путей, инфицированный асцит, спонтанный бактериальный перитонит) [2], наблюдающиеся у 47% госпитализированных пациентов [3] и являющиеся триггером декомпенсации ЦП [4]. Анализ литературных источников свидетельствует о том, что в настоящее время много внимания уделяется изучению при ЦП факторов риска, патогенетических механизмов инфекционных осложнений, в том числе роли иммунологических расстройств в развитии осложнений ЦП [5,6].…”