Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis.

Fernández, Javier; Acevedo, Juan; Wiest, Reiner; Gustot, Thierry; Amoros, Alex; Deulofeu, Carme; Reverter, Enric; Martínez, Javier; Saliba, Faouzi; Jalan, Rajiv; Welzel, Tania; Pavesi, Marco; Hernández-Tejero, María; Ginès, Pere; Arroyo, Vicente (2018). Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis. Gut, 67(10), pp. 1870-1880. BMJ Publishing Group 10.1136/gutjnl-2017-314240

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Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival.

PATIENTS

407 patients with ACLF and 235 patients with acute decompensation (AD).

RESULTS

152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%).

CONCLUSION

Bacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Gastroenterologie / Mukosale Immunologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Gastroenterologie / Mukosale Immunologie

UniBE Contributor:

 Wiest, Reiner

Subjects:

 600 Technology > 610 Medicine & health

ISSN:

 0017-5749

Publisher:

 BMJ Publishing Group

Language:

 English

Submitter:

 Thi Thao Anh Pham

Date Deposited:

 01 Feb 2018 09:49

Last Modified:

 05 Dec 2022 15:10

Publisher DOI:

 10.1136/gutjnl-2017-314240

PubMed ID:

 28847867

Uncontrolled Keywords:

 cirrhosis clinical course immune paralysis mortality prevalence prognosis prophylaxis

BORIS DOI:

 10.7892/boris.110315

URI:

 https://boris.unibe.ch/id/eprint/110315

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