Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis

Abstract

Alcohol-associated hepatitis (AAH) is a severe form of liver injury with mortality as high as 30%-40% at 90 days. As a result of altered immune function in AAH, bacterial infections are common and are associated with poor outcomes. However, determining the risk and subsequent development of infection in patients with AAH remain challenging. We performed a retrospective study of consecutive patients admitted with a diagnosis of AAH at two independent tertiary centers from 1998 to 2018 (test cohort, n = 286) who developed infections following hospitalization. The diagnosis of AAH was confirmed by manual chart review according to the recent National Institute on Alcohol Abuse and Alcoholism definition. Infections were categorized by location and time of diagnosis as hospital-acquired infection (48 hours after admission until discharge) and posthospital infections (up to 6 months following discharge). The cohort was 66% men, and the median age was 48 (21-83) years. Corticosteroids were used in 32% of all patients with AAH. The overall infection rate was 24%. Of those with infections, 46% were hospital acquired and 54% were acquired after hospitalization. Variables found to be significant risk factors for bacterial infection included the presence of ascites on admission (hazard ratio [HR], 2.06), corticosteroid administration (HR, 1.70), Model for End-Stage Liver Disease (MELD) >23 (HR, 2.61), and white blood cell (WBC) count on admission per point (HR, 1.02). Conclusion: In this multicenter cohort study of patients hospitalized with AAH, MELD score, ascites, WBC count, and use of corticosteroids were identified as significant predictors of the development of bacterial infection. We created a novel predictive equation that may be used to aid in the identification of patients with AAH at high risk of infection. (Hepatology Communications 2021;0:1-8).A lcohol-associated hepatitis (AAH) is a serious form of alcohol-associated liver disease, estimated to occur in up to 35% of patients with alcohol use disorder. (1) Severe cases of AAH are characterized by new onset jaundice and are classified by the Maddrey's discriminant function (MDF) or the Model for End-Stage Liver Disease (MELD). (1)(2)(3) Infections are common in severe AAH, with approximately 25% of patients presenting with communityacquired infection and a similar percentage found to develop nosocomial infections. (4) The high rates of sepsis observed in AAH may be explained by

Profiling of nosocomial infection in hepatic patients

“…In this study, chronic liver disease male patients (130(62.8%)) with mean age of (49.5 ± 11.9) years had significant increase in incidence of NCI. 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].…”

Assessment of immune function and prediction of survival and infection in patients with severe alcoholic hepatitis: An exploratory study

“…Patients with AH are at high risk of developing infection, a major cause of mortality in this setting, which is increased by up to 70% with corticosteroid treatment 4,11 . The most common infections are urinary tract infection, bacteremia, lower respiratory tract infection, and spontaneous bacterial peritonitis (SBP) 12–14 . The high incidence of infections is associated with immune dysfunction; increased T‐cell exhaustion leads to reduced ability to prevent bacterial infection 5,10 .…”

“… 4 , 11 The most common infections are urinary tract infection, bacteremia, lower respiratory tract infection, and spontaneous bacterial peritonitis (SBP). 12 , 13 , 14 The high incidence of infections is associated with immune dysfunction; increased T‐cell exhaustion leads to reduced ability to prevent bacterial infection. 5 , 10 Despite high circulating levels of pro‐inflammatory cytokines TNF‐α, IL‐8, and IL‐17, which are anti‐pathogenic in other conditions, 15 , 16 immune cells are refractory to stimulation by microbial products in patients with AH, suggesting an impaired response to infection.…”

Antibacterial activities of Polyalthia longifolia leaf extracts on multiple antibiotic-resistant bacteria isolated from hospital fomites in Akure, Nigeria

“…There have also been reports of organisms responsible for nosocomial infections exhibiting resistance to several medicines, making it harder to treat bacterial infections. In addition, new patients who move into a room previously occupied by a patient with MAR infections are at an increased risk of contracting these pathogens because they are more likely to come into contact with them (Penrice et al 2021).…”