Lopes-Secundo Tirzah M, Sevá-Pereira Tiago, Correa Bárbara R, Silva Natalie C M, Imbrizi Marcello R, Cunha-Silva Marlone, Soares Elza C, Almeida Jazon R S
Gastroenterology Division, Faculty of Medical Sciences, University of Campinas (UNICAMP) and.
Tiradentes University (UNIT), Brazil.
Eur J Gastroenterol Hepatol. 2018 Sep;30(9):1055-1059. doi: 10.1097/MEG.0000000000001184.
Bacterial infection is present in up to 30% of hospitalized cirrhotic patients. It can lead, even after its resolution, to organ dysfunction and even acute-on-chronic liver failure (ACLF). It is the precipitating factor of ACLF in one third of the cases and is the main cause of mortality in patients with liver cirrhosis.
The aim of this study was to evaluate the prevalence and identify early risk factors for severe ACLF and death in hospitalized patients with liver cirrhosis with bacterial infection.
This was a prospective observational study. Hospitalized patients with liver cirrhosis and bacterial infection were included. Clinical and laboratory data and their evolution to organ dysfunction and death were assessed. A statistical analysis were carried out to identify predictors of severe ACLF and in-hospital mortality.
This study included 88 patients. ACLF was observed in 62 (70%) patients, with 48 (55%) grade 2 or higher. Of the 27 deaths (31% of all patients), 26 had severe ACLF (54% mortality) (P<0.0001). The independent risk factors for ACLF of at least 2 and death were baseline serum sodium [odds ratio (OR): 0.874; P=0.01, and OR: 0.9, P=0.04], initial MELD (OR: 1.255, P=0.0001, and OR: 1.162, P=0.005), and a recent invasive procedure (OR: 3.169, P=0.01, and OR: 6.648, P=0.003).
Lower serum sodium values, higher MELD scores at diagnosis of infection, and a recent history of invasive procedures were independent risk factors for severe ACLF and death in patients with cirrhosis and bacterial infection.
高达30%的住院肝硬化患者存在细菌感染。即使感染得到解决，它也可能导致器官功能障碍，甚至慢加急性肝衰竭（ACLF）。在三分之一的病例中，它是ACLF的诱发因素，也是肝硬化患者死亡的主要原因。
本研究的目的是评估住院肝硬化合并细菌感染患者中严重ACLF和死亡的患病率，并确定早期危险因素。
这是一项前瞻性观察性研究。纳入住院的肝硬化合并细菌感染患者。评估临床和实验室数据以及它们向器官功能障碍和死亡的进展情况。进行统计分析以确定严重ACLF和院内死亡率的预测因素。
本研究纳入了88例患者。62例（70%）患者出现ACLF，其中48例（55%）为2级或更高级别。在27例死亡患者（占所有患者的31%）中，26例患有严重ACLF（死亡率54%）（P<0.0001）。ACLF至少为2级和死亡的独立危险因素为基线血清钠[比值比（OR）：0.874；P=0.01，以及OR：0.9，P=0.04]、初始终末期肝病模型（MELD）评分（OR：1.255，P=0.0001，以及OR：1.162，P=0.005）和近期侵入性操作（OR：3.169，P=0.01，以及OR：6.648，P=0.003）。
较低的血清钠值、感染诊断时较高的MELD评分以及近期侵入性操作史是肝硬化合并细菌感染患者发生严重ACLF和死亡的独立危险因素。
