Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, India, India.
Dig Liver Dis. 2018 Nov;50(11):1225-1231. doi: 10.1016/j.dld.2018.05.013. Epub 2018 May 28.
Acute on chronic liver failure (ACLF) is associated with high short term mortality. We aimed to evaluate the prevalence, predictors and impact of bacterial infection in ACLF.
Consecutive hospitalized patients with cirrhosis and acute decompensation (AD), from January 2011-March 2017, were included. Predictors of survival and infection were assessed.
572 patients with cirrhosis and AD were classified into 3 groups - no infection (group 1, n = 190, 33.2%), infection at admission/within 48 h (group 2, n = 298, 52.1%) and infection after 48 h (group 3, n = 84, 14.7%). Higher frequency of organ failures - kidney, brain, circulation and respiratory failure - were seen in groups 2 and 3 as compared with group 1 (P < 0.001 for all). Most common site of infection was lungs, followed by spontaneous bacterial peritonitis and urinary tract infection. The frequency of infection increased with higher ACLF grades. Among ACLF patients, on Cox-proportional multivariate analysis, presence of infection was associated with significantly higher mortality [group 2 (HR 2.93; 95%CI, 1.97-4.38, P < 0.001) and group 3 (HR 1.84; 95%CI, 1.16-2.91, P = 0.009)], as compared with group 1. On multivariate logistic regression analysis, advanced hepatic encephalopathy and elevated total leucocyte count were independently associated with development of infection.
Infections are common in ACLF, and associated with poor outcome.
慢性加急性肝衰竭（ACLF）与高短期死亡率相关。我们旨在评估 ACLF 中细菌感染的患病率、预测因素和影响。
纳入 2011 年 1 月至 2017 年 3 月连续住院的肝硬化和急性失代偿（AD）患者。评估了生存和感染的预测因素。
572 例肝硬化和 AD 患者分为 3 组 - 无感染（第 1 组，n=190，33.2%）、入院/48 小时内感染（第 2 组，n=298，52.1%）和 48 小时后感染（第 3 组，n=84，14.7%）。与第 1 组相比，第 2 组和第 3 组的器官衰竭（肾脏、大脑、循环和呼吸衰竭）频率更高（所有 P<0.001）。感染的最常见部位是肺部，其次是自发性细菌性腹膜炎和尿路感染。ACLF 分级越高，感染的频率越高。在 ACLF 患者中，Cox 比例风险多变量分析显示，存在感染与死亡率显著升高相关[第 2 组（HR 2.93；95%CI，1.97-4.38，P<0.001）和第 3 组（HR 1.84；95%CI，1.16-2.91，P=0.009）]，与第 1 组相比。多变量逻辑回归分析显示，晚期肝性脑病和白细胞总数升高与感染的发生独立相关。
感染在 ACLF 中很常见，与不良预后相关。
