Virginia Commonwealth University and McGuire Virginia Medical Center, Richmond, Virginia, USA.
Baylor University Medical Center, Dallas, Texas, USA.
Am J Gastroenterol. 2019 Jul;114(7):1091-1100. doi: 10.14309/ajg.0000000000000280.
Nosocomial infections (NIs) can be a major cause of morbidity and mortality in cirrhosis. This study aims to define the determinants of NI development and its impact on 30-day outcomes among hospitalized patients with cirrhosis.
North American Consortium for the Study of End-Stage Liver Disease enrolled patients with cirrhosis who were admitted nonelectively. Admission variables and 30-day outcomes were compared between patients with and without NI. These were also compared based on whether there was an isolated admission infection, NI, or both. Models were created for NI development using admission variables and for 30-day mortality.
The study included 2,864 patients; of which, 15% (n = 436) developed NI. When comparing NI vs no NI, 1,866 patients were found to be infection free, whereas 562 had admission infections only, 228 had only NI, and 208 had both infections. At admission, patients with NI were more likely to be infected and have advanced cirrhosis. NIs were associated with higher rates of acute-on-chronic liver failure, death, and transplant regardless of admission infections. Patients with NI had higher respiratory infection, urinary tract infection, Clostridium difficile infection, fungal infections, and infection with vancomycin-resistant enterococci compared with patients without NI. Risk factors for NIs were admission infections, model for end-stage liver disease (MELD) > 20, systemic inflammatory response syndrome criteria, proton pump inhibitor, rifaximin, and lactulose use, but the regression model (sensitivity, 0.67; specificity, 0.63) was not robust. Age, alcohol etiology, admission MELD score, lactulose use, acute-on-chronic liver failure, acute kidney injury, intensive care unit, and NI increased the risk of death, whereas rifaximin decreased the risk of death.
NIs are prevalent in hospitalized patients with cirrhosis and are associated with poor outcomes. Although higher MELD scores and systemic inflammatory response syndrome are associated with NI, all hospitalized patients with cirrhosis require vigilance and preventive strategies.
医院获得性感染（NI）可能是肝硬化患者发病率和死亡率的主要原因。本研究旨在确定 NI 发展的决定因素及其对住院肝硬化患者 30 天结局的影响。
北美终末期肝病研究联合会纳入了非择期住院的肝硬化患者。比较了 NI 患者和非 NI 患者的入院变量和 30 天结局。还比较了是否存在孤立性入院感染、NI 或两者均有的患者。根据入院变量和 30 天死亡率建立了 NI 发展模型。
本研究纳入了 2864 例患者；其中，15%（n=436）发生了 NI。与无 NI 相比，1866 例患者无感染，562 例患者仅有入院感染，228 例患者仅有 NI，208 例患者同时存在感染。入院时，NI 患者更有可能感染且肝硬化更严重。无论是否存在入院感染，NI 均与更高的急性肝衰竭、死亡和移植率相关。与无 NI 患者相比，NI 患者更易发生呼吸道感染、尿路感染、艰难梭菌感染、真菌感染和耐万古霉素肠球菌感染。NI 的危险因素包括入院感染、终末期肝病模型（MELD）>20、全身炎症反应综合征标准、质子泵抑制剂、利福昔明和乳果糖的使用，但回归模型（敏感性为 0.67；特异性为 0.63）并不稳健。年龄、酒精病因、入院 MELD 评分、乳果糖使用、急性肝衰竭、急性肾损伤、重症监护病房和 NI 增加了死亡风险，而利福昔明降低了死亡风险。
NI 在住院肝硬化患者中很常见，与不良结局相关。尽管更高的 MELD 评分和全身炎症反应综合征与 NI 相关，但所有住院肝硬化患者均需保持警惕并采取预防策略。
