Second infections independently increase mortality in hospitalized patients With cirrhosis: the north american consortium for the study of end-stage liver disease (NACSELD) experience

Bajaj, Jasmohan S.; O’Leary, Jacqueline G.; Reddy, K. Rajender; Wong, Florence; Olson, Jody C.; Subramanian, Ram; Brown, Geri; Noble, Nicole A.; Thacker, Leroy R.; Kamath, Patrick S.

doi:10.1002/hep.25947

Cited by 365 publications

(391 citation statements)

References 24 publications

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“…In contrast to antimicrobials that disrupt the normal gut microbiome, facilitating the proliferation of C. difficile, 34 and in contrast to gastricacid suppressive medication that may allow survival of vegetative forms of C. difficile, 35 a plausible biological mechanism for the observed association could be the negative impact of corticosteroids on the gastrointestinal mucosal integrity. 36 Previous studies found that gastrointestinal comorbidities such as inflammatory bowel disease 12 and cirrhosis 14 were associated with a worse prognosis in patients with CDI. Similarly, congestive heart disease, chronic pulmonary disease, renal failure, and malignant neoplasms were also associated with higher mortality rates among inpatients with CDI.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Furuya‐Kanamori

Stone

Clark³

et al. 2014

Infect. Control Hosp. Epidemiol.

142

103

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background. Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI. methods. A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted.

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Section: Discussionmentioning

confidence: 99%

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Furuya‐Kanamori

Stone

Clark³

et al. 2014

Infect. Control Hosp. Epidemiol.

142

103

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“…The APASL group considers only hepatic insults/injury as acute precipitating event, whereas EASL also includes extrahepatic insult such as the sepsis and upper gastrointestinal bleeding as a cause of acute insult. 2,[4][5][6][7] The chronic liver failure (CLIF) acute-on-chronic liver failure in cirrhosis (CANONIC) study has defined ACLF based on increased 28-day mortality in patients with liver cirrhosis and acute decompensation. In a previous study, we have demonstrated chronic liver failure-sequential organ failure assessment (CLIF-SOFA) criteria to be better than APASL criteria in defining ACLF.…”

mentioning

confidence: 99%

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Gupta

Dhiman

Rathi

et al. 2017

Journal of Clinical and Experimental Hepatology

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Background: To study the differences in outcome and predictors of mortality in acute-on-chronic liver failure (ACLF) precipitated by hepatic or extrahepatic insults. Methods: Consecutive patients of cirrhosis with acute decompensation were prospectively included and followed up for 90 days from admission. ACLF was defined based on chronic liver failure (CLIF) acute-on-chronic liver failure in cirrhosis (CANONIC study) criteria. Acute worsening due to acute viral hepatitis A and E, hepatitis B flare, alcoholic hepatitis, autoimmune hepatitis flare, or drug-induced liver injury were categorized as hepatic ACLF and that due to bacterial infection, upper gastrointestinal bleed or surgery as extrahepatic ACLF. Patients with both hepatic and extrahepatic insults were included in combined insult group. Results: Of 179 patients of acute decompensation, 122 had ACLF (hepatic insults 47 and extrahepatic insults 51). Alcohol (64.8%) was the most common etiology of cirrhosis while infection (36%) was the most common acute insult followed by alcoholic hepatitis (24.6%). Higher proportion of extrahepatic ACLF patients had history of prior decompensation than hepatic ACLF patients (62.7% vs. 27.7%, P < 0.001). There was no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days (53.2% vs. 56.9%, P = 0.715 and 85% vs. 74.5%, P = 0.193, respectively). Area under receiver-operating curve (AUROC) for 28-day mortality in extrahepatic ACLF group was 0.788, 0.724, 0.718, 0.634, and 0.726 and in hepatic-ACLF group was 0.786, 0.625, 0.802, 0.761, and 0.648 for chronic liver failure-sequential organ failure assessment (CLIF-SOFA), model for end stage liver disease (MELD), integrated MELD score (iMELD), acute physiology and chronic health evaluation score (APACHE-II), and Child-Turcotte-Pugh score scores, respectively. Conclusion: There is no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days. iMELD and CLIF-SOFA have highest AUROC to predict 28-day mortality in hepatic and extrahepatic ACLF groups, respectively. ( J CLIN EXP HEPATOL 2017;7:9-15)

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“…(1,31) Patient data were recorded in a REDCAP database. The study protocol was approved by the institutional review boards in all participating centers, and all patients or their family members provided written informed consent for study inclusion.…”

Section: Methodsmentioning

confidence: 99%

A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis

et al. 2017

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Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate , and high (80-100). Of 954 middle-aged patients (57 6 10 years, 63% men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23% (36/ 159), 11% (55/489), and 5% (15/306), respectively. Low, intermediate, and high performance status was seen in 17%, 51%, and 32% of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve 5 0.74) than a model using MELD (area under the receiver operating characteristic curve 5 0.62) or MELD and age (area under the receiver operating characteristic curve 5 0.67) to predict 3-month mortality. Conclusions: Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies. (HEPATOLOGY 2017;65:217-224).P atients with cirrhosis can experience sudden deteriorations in health that lead to increased morbidity, repeated hospitalizations, and mortality. (1)(2)(3) Hospitalization is a marker for a variety of poor outcomes including readmission and death. Although we are gaining a better understanding of risk factors for readmission in discharged patients, (1,(4)(5)(6) we lack a practical prognostic model to identify those at highest risk for 3-month postdischarge mortality.Identifying this group would facilitate interventions that include more intensive follow-up and consideration of early liver transplant when available. Moreover, an estimation of the probability of survival can help to inform the type of integrated palliative support that is provided to patients.To date, mortality prediction in patients with cirrhosis has been predominated by liver-specific and kidney-specific prognostic indicators such as the Abbreviations: AUC, area under the receiver operating characteristic curve; CI, confidence interval; HE, hepatic encephalopathy; KAM, KPS, age, MELD (model); KPS, Karnofsky Performance Status; MELD, Model for End-Stage Liver Disease; OR, odd...

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Second infections independently increase mortality in hospitalized patients With cirrhosis: the north american consortium for the study of end-stage liver disease (NACSELD) experience

Cited by 365 publications

References 24 publications

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis

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