Choi Seong-Ho, Park Hyun-Gu, Jun Jae Bum, Lee Sang-Oh, Choi Sang-Ho, Woo Jun Hee, Kim Yang Soo
Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea.
Diagn Microbiol Infect Dis. 2009 Feb;63(2):160-4. doi: 10.1016/j.diagmicrobio.2008.10.018.
Few studies have assessed the clinical characteristics and outcomes of invasive pneumococcal diseases in cirrhotic patients. We reviewed the medical records of adult cirrhotic patients with pneumococcal bacteremia from January 1997 to April 2006. During this time, 62 episodes of pneumococcal bacteremia occurred in 59 patients with liver cirrhosis, 45 (76.3%) of whom were classified as Child-Pugh grade C. The most common source of infection was spontaneous bacterial peritonitis (SBP) (45.8%), followed by primary bacteremia (40.7%) and pneumonia (10.1%). The 30-day mortality rate was 16.9%, with all fatalities in patients classified as Child-Pugh grade C. The median model for end-stage liver disease score of patients who died was significantly higher than that of survivors (26.5 versus 17.0, P=0.001). Pneumococcal bacteremia in adult cirrhotic patients was more commonly associated with SBP than with pneumonia. Most cases of bacteremia and fatal outcomes occurred in patients with advanced cirrhosis.
很少有研究评估肝硬化患者侵袭性肺炎球菌疾病的临床特征和转归。我们回顾了1997年1月至2006年4月期间成年肝硬化患者肺炎球菌菌血症的病历。在此期间，59例肝硬化患者发生了62次肺炎球菌菌血症发作，其中45例（76.3%）被归类为Child-Pugh C级。最常见的感染源是自发性细菌性腹膜炎（SBP）（45.8%），其次是原发性菌血症（40.7%）和肺炎（10.1%）。30天死亡率为16.9%，所有死亡病例均为Child-Pugh C级患者。死亡患者的终末期肝病评分中位数显著高于存活患者（26.5对17.0，P=0.001）。成年肝硬化患者的肺炎球菌菌血症与SBP的相关性比与肺炎的相关性更强。大多数菌血症病例和致命结局发生在晚期肝硬化患者中。
