4th Medical Department, Klinikum Süd, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
2nd Medical Department, Technische Universität München, Klinikum rechts der Isar, Germany.
Ann Hepatol. 2018 Oct 16;17(6):948-958. doi: 10.5604/01.3001.0012.7195.
We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions.
We performed a prospective observational monocentric study in a tertiary care center. The association of clinical parameters and established scoring systems with short-term mortality up to 90 days was assessed by univariate and multivariable Cox regression analysis. Akaike's Information Criterion (AIC) was used for automated variable selection. Statistical interaction effects with infection were also taken into account.
218 patients were included. 71.2% were male, mean age was 61.1 ± 10.5 years. Mean MELD score was 16.2 ± 6.5, CLIF-consortium Acute on Chronic Liver Failure-score was 34 ± 11. At 28, 90 and 365 days, 9.6%, 26.0% and 40.6% of patients had died, respectively. In multivariable analysis, respiratory organ failure [Hazard Ratio (HR) = 0.15], albumin substitution (HR = 2.48), non-HCC-malignancy (HR = 4.93), CLIF-C-ACLF (HR = 1.10), HCC (HR = 3.70) and first episode of ascites (HR = 0.11) were significantly associated with 90-day mortality. Patients with infection had a significantly higher 90-day mortality (36.3 vs. 20.1%, p = 0.007). Cultures were positive in 32 patients with resistance to cephalosporins or quinolones in 10, to ampicillin/sulbactam in 14 and carbapenems in 6 patients.
Infection is common in cirrhotic ED admissions and increases mortality. The proportion of resistant microorganisms is high. The predictive capacity of established scoring systems in this setting was low to moderate.
我们旨在探讨入院时诊断的感染以及其他临床基线参数对急诊入院肝硬化患者死亡率的影响。
我们在一家三级护理中心进行了一项前瞻性观察性单中心研究。通过单变量和多变量 Cox 回归分析评估了临床参数和既定评分系统与 90 天内短期死亡率的关系。Akaike 信息准则 (AIC) 用于自动选择变量。还考虑了与感染的统计交互效应。
共纳入 218 例患者。71.2%为男性，平均年龄为 61.1 ± 10.5 岁。平均 MELD 评分为 16.2 ± 6.5，CLIF 联盟急性慢性肝衰竭评分 (CLIF-C ACLF) 为 34 ± 11。在 28、90 和 365 天时，分别有 9.6%、26.0%和 40.6%的患者死亡。多变量分析显示，呼吸器官衰竭 [风险比 (HR) = 0.15]、白蛋白替代治疗 (HR = 2.48)、非 HCC 恶性肿瘤 (HR = 4.93)、CLIF-C-ACLF (HR = 1.10)、HCC (HR = 3.70) 和首次腹水发作 (HR = 0.11) 与 90 天死亡率显著相关。感染患者的 90 天死亡率显著更高（36.3%比 20.1%，p = 0.007）。32 例患者的培养物呈阳性，其中 10 例对头孢菌素或喹诺酮类药物耐药，14 例对氨苄西林/舒巴坦耐药，6 例对碳青霉烯类药物耐药。
感染在肝硬化 ED 入院中很常见，并且会增加死亡率。耐药微生物的比例很高。在这种情况下，既定评分系统的预测能力较低到中等。
