Hung Tsung-Hsing, Tsai Chih-Chun, Lee Hsing-Feng
Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2019 Feb 18;32(1):47-52. doi: 10.4103/tcmj.tcmj_142_18. eCollection 2020 Jan-Mar.
Ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and esophageal variceal bleeding are major complications associated with cirrhosis. The presence of these complications indicates poor hepatic reserve. This study aimed to identify the effects of poor hepatic reserve on mortality in cirrhotic patients with bacterial infections.
The Taiwan National Health Insurance Database was used to identify 43,042 cirrhotic patients with bacterial infections hospitalized between January 1, 2010, and December 31, 2013, after propensity score matching analysis. Of these, 21,521 cirrhotic patients had major cirrhotic-related complications and were considered to have poor hepatic reserve.
Mortality rates at 30 and 90 days were 24.2% and 39.5% in the poor hepatic reserve group and 12.8% and 21.7% in the good hepatic reserve group, respectively ( < 0.001 for each group). The cirrhotic patients with poor hepatic reserve (hazard ratio [HR], 2.10; 95% confidence interval [CI] = 2.03-2.18; < 0.001) had significantly increased mortality at 90 days. The mortality HRs in patients with one, two, and three or more complications compared to patients without complications were 1.92 (95% CI = 1.85-1.99, < 0.001), 2.61 (95% CI = 2.47-2.77, < 0.001), and 3.81 (95% CI = 3.18-4.57, < 0.001), respectively.
In cirrhotic patients with bacterial infections, poor hepatic reserve is associated with a poor prognosis. The presence of three or more cirrhotic-related complications increases mortality almost four folds.
腹水、肝性脑病、肝肾综合征、自发性细菌性腹膜炎和食管静脉曲张破裂出血是肝硬化相关的主要并发症。这些并发症的出现表明肝脏储备功能差。本研究旨在确定肝脏储备功能差对肝硬化合并细菌感染患者死亡率的影响。
在进行倾向得分匹配分析后，利用台湾国民健康保险数据库确定了2010年1月1日至2013年12月31日期间住院的43042例肝硬化合并细菌感染患者。其中，21521例肝硬化患者出现了主要的肝硬化相关并发症，被认为肝脏储备功能差。
肝脏储备功能差的患者30天和90天死亡率分别为24.2%和39.5%，肝脏储备功能良好的患者分别为12.8%和21.7%（每组均<0.001）。肝脏储备功能差的肝硬化患者90天死亡率显著增加（风险比[HR]，2.10；95%置信区间[CI]=2.03-2.18；<0.001）。与无并发症的患者相比，有1种、2种和3种及以上并发症的患者的死亡HR分别为1.92（95%CI=1.85-1.99，<0.001）、2.61（95%CI=2.47-2.77，<0.001）和3.81（95%CI=3.18-4.57，<0.001）。
在肝硬化合并细菌感染的患者中，肝脏储备功能差与预后不良相关。出现3种及以上肝硬化相关并发症会使死亡率增加近4倍。
