Piano Salvatore, Morando Filippo, Carretta Giovanni, Tonon Marta, Vettore Elia, Rosi Silvia, Stanco Marialuisa, Pilutti Chiara, Romano Antonietta, Brocca Alessandra, Sticca Antonietta, Donato Daniele, Angeli Paolo
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padova, Italy.
Medical Directorate, Hospital of Padova, Padova, Italy.
Am J Gastroenterol. 2017 Oct;112(10):1575-1583. doi: 10.1038/ajg.2017.253. Epub 2017 Aug 29.
In patients with cirrhosis, infections represent a frequent trigger for complications, increasing frequency of hospitalizations and mortality rate. This study aimed to identify predictors of early readmission (30 days) and of mid-term mortality (6 months) in patients with liver cirrhosis discharged after a hospitalization for bacterial and/or fungal infection.
A total of 199 patients with cirrhosis discharged after an admission for a bacterial and/or fungal infection were included in the study and followed up for a least 6 months.
During follow-up, 69 patients (35%) were readmitted within 30 days from discharge. C-reactive protein (CRP) value at discharge (odds ratio (OR)=1.91; P=0.022), diagnosis of acute-on-chronic liver failure during the hospital stay (OR=2.48; P=0.008), and the hospitalization in the last 30 days previous to the admission/inclusion in the study (OR=1.50; P=0.042) were found to be independent predictors of readmission. During the 6-month follow-up, 47 patients (23%) died. Age (hazard ratio (HR)=1.05; P=0.001), model of end-stage liver disease (MELD) score (HR=1.13; P<0.001), CRP (HR=1.85; P=0.001), refractory ascites (HR=2.22; P=0.007), and diabetes (HR=2.41; P=0.010) were found to be independent predictors of 6-month mortality. Patients with a CRP >10 mg/l at discharge had a significantly higher probability of being readmitted within 30 days (44% vs. 24%; P=0.007) and a significantly lower probability of 6-month survival (62% vs. 88%; P<0.001) than those with a CRP ≤10 mg/l.
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.
在肝硬化患者中，感染是并发症的常见诱因，会增加住院频率和死亡率。本研究旨在确定因细菌和/或真菌感染住院后出院的肝硬化患者早期再入院（30天）和中期死亡率（6个月）的预测因素。
本研究纳入了199例因细菌和/或真菌感染入院后出院的肝硬化患者，并对其进行了至少6个月的随访。
在随访期间，69例患者（35%）在出院后30天内再次入院。出院时的C反应蛋白（CRP）值（比值比（OR）=1.91；P=0.022）、住院期间慢性肝衰竭急性发作的诊断（OR=2.48；P=0.008）以及在入院/纳入研究前的最后30天内住院（OR=1.50；P=0.042）被发现是再入院的独立预测因素。在6个月的随访期间，47例患者（23%）死亡。年龄（风险比（HR）=1.05；P=0.001）、终末期肝病模型（MELD）评分（HR=1.13；P<0.001）、CRP（HR=1.85；P=0.
