Predictors of Early Readmission in Patients With Cirrhosis After the Resolution of Bacterial Infections

Abstract

CRP showed to be a strong predictor of early hospital readmission and 6-month mortality in patients with cirrhosis after hospitalization for bacterial and/or fungal infection. CRP values could be used both in the stewardship of antibiotic treatment and to identify fragile patients who deserve a strict surveillance program.

Infections complicating cirrhosis

“…The usefulness of CRP and PCT in the stewardship of antibiotic treatment requires further investigation in cirrhosis, but they are promising. In particular, a CRP level at discharge below 10 mg/dL was found to be associated with a lower risk of rehospitalization for bacterial infections …”

“…In particular, a CRP level at discharge below 10 mg/dL was found to be associated with a lower risk of rehospitalization for bacterial infections. 26 Diagnostic criteria for bacterial infections in patients with cirrhosis are similar to those in the general population. However, spontaneous infections that may occur in patients with cirrhosis, such as SBP, spontaneous empyema and spontaneous bacteraemia, deserve a more de- host response to infection.…”

Significant reduction in heart rate variability is a feature of acute decompensation of cirrhosis and predicts 90‐day mortality

“…Moreover, there was also a weak but statistically significant association between low SDNN and increased concentrations of the pro-inflammatory cytokine IL-6 but only a trend of an association with IL-8. The recent literature in decompensated cirrhosis patients has highlighted the pathophysiologic significance of systemic inflammatory response, as demonstrated by raised leucocyte counts and more recently elevated CRP, as being associated with poor outcome 10,26. The loss of HRV as indicated by reduction in SDNN may, therefore, reflect a response to inflammation, whether driven by infection or a sterile inflammatory response, as often seen in ACLF 21,22.…”

“…Similarly, following traumatic brain injury, there is a reduction in HRV and this is associated with a change in immune responses,24,25 whilst in patients treated for sepsis, reduced SDNN has been linked to poor outcome 12. The recent literature in decompensated cirrhosis patients has highlighted the pathophysiologic significance of systemic inflammatory response, as demonstrated by raised leucocyte counts and more recently elevated CRP, as being associated with poor outcome 10,26. Of interest, in this study, only SDNN was an independent predictor of mortality.…”

Management of Sepsis in Patients With Cirrhosis: Current Evidence and Practical Approach

“…It has been proposed that in stable critically ill patients, procalcitonin levels of <0.5 µg/L or a decrease ≥80% from peak can be used as supportive data in discontinuation of antibiotic treatment . The therapeutic guiding role of procalcitonin levels has not been established in patients with cirrhosis, but its role as a biomarker of bacterial infections has been validated …”