Nosocomial infections in female compared with male patients with decompensated liver cirrhosis

Abstract

There are considerable differences between males and females regarding the etiology, progression and outcome of liver diseases. Infections are a frequent and severe complication in these patients. This study aimed to examine sex specific differences in the incidence and clinical course of nosocomial infections in patients with decompensated liver cirrhosis. A number of 556 consecutive hospitalized patients with decompensated liver cirrhosis and ascites were analyzed. The patients were followed up for the incidence of nosocomial infections, acute kidney injury (AKI), acute-on-chronic liver failure (ACLF) as well as liver transplantation and death (LTx-free survival). A number of 285 patients (111 women and 174 men) developed a nosocomial infection. Incidence was numerically lower in men (P = 0.076). While the frequency of a nosocomial spontaneous bacterial peritonitis was similar between males and females, the incidence of a nosocomial urinary tract infection was significantly higher in women (P < 0.001). No sex specific differences were documented regarding the outcome of an infection as indicated by a similar incidence of, AKI, ACLF as well as LTx-free survival. There seem to be no major differences in the incidence and outcome of nosocomial infections between male and female patients.

Profiling of nosocomial infection in hepatic patients

“…This was in agree with Penrice et al who mentioned that 66% men, and the median age was 48 [20]. On the other hand, Griemsmann et al found no major differences in the incidence and outcome of nosocomial infections between male and female patients [3].…”

“…In this study, CRASBI shows Gram positive pathogen predominance which was non-significant. Comparable results obtained by other authors [3]. On the other hand, Gustot et al found that Spontaneous bacterial peritonitis (SBP) is often identified as the most frequent infection in cirrhosis, followed by urinary tract infection and pneumonia [26].…”

“…Nosocomial infections are without a doubt one of the major hazards when managing female as well as male patients with end-stage liver disease. Early diagnosis, immediate treatment and in particular the development of prophylactic measures are key challenges to improve patients' outcome [3]. Nosocomial infections could lead to considerably higher mortality rates, length of the hospital stays and costs, and represent a serious public health concern worldwide.…”

“…Nosocomial infection represents the higher rate of failure to empirical treatment, failure to design treatment protocols, poor response to available lines with increased mortality rates [3]. Nosocomial infection has been classified into 14 different types.…”

Acute decompensation of cirrhosis versus acute‐on‐chronic liver failure: What are the clinical implications?

“…Additionally, with the increasing pipeline of potential disease‐modifying treatments, there is an unmet need to accurately distinguish eligible patients for these treatments from those who should be referred for liver transplantation (Figure 2). Finally, despite initial data indicating that the clinical presentation and natural progression of events are not sex‐specific in AD and ACLF, additional research is needed to validate this observation 3,4,39,79–81 . In any case, evidence is accumulating regarding the sex‐specificity of clinical and biological markers of severity 82,83 …”