CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France.
CHU Rennes, Centre d'investigation clinique, Rennes, France.
Infect Dis (Lond). 2023 Jul;55(7):480-489. doi: 10.1080/23744235.2023.2213326. Epub 2023 May 21.
Acute liver failure (ALF) is a rare but life-threatening condition mostly requiring intensive care unit (ICU) admission. ALF induces immune disorders and may promote infection acquisition. However, the clinical spectrum and impact on patients' prognosis remain poorly explored.
We conducted a retrospective single-centre study on patients admitted for ALF to the ICU of a referral University Hospital from 2000 to 2021. Baseline characteristics and outcomes according to the presence of infection until day 28 were analysed. Risk factors for infection were determined using logistic regression. The impact of infection on 28-day survival was assessed using the proportional hazard Cox model.
Of the 194 patients enrolled, 79 (40.7%) underwent infection: community-acquired, hospital-acquired before ICU and ICU-acquired before/without and after transplant in 26, 23, 23 and 14 patients, respectively. Most infections were pneumonia (41.4%) and bloodstream infection (38.8%). Of a total of 130 microorganisms identified, 55 were Gram-negative bacilli (42.3%), 48 Gram-positive cocci (36.9%) and 21 were fungi (16.2%). Obesity (OR 3.77 [95% CI 1.18-14.40]; = .03) and initial mechanical ventilation (OR 2.26 [95% CI 1.25-4.12]; = .007) were independent factors associated with overall infection. SAPSII > 37 (OR 3.67 [95% CI 1.82-7.76], < .001) and paracetamol aetiology (OR 2.10 [95% CI 1.06-4.22], = .03) were independently associated with infection at admission to ICU. On the opposite, paracetamol aetiology was associated with lower risk of ICU-acquired infection (OR 0.37 [95% CI 0.16-0.81], = .02). Patients with any type of infection had lower day 28 survival rates (57% versus 73%; HR 1.65 [1.01-2.68], = .04). The presence of infection at ICU admission ( = .04), but not ICU-acquired infection, was associated with decreased survival.
The prevalence of infection is high in ALF patients which is associated with a higher risk of death. Further studies assessing the use of early antimicrobial therapy are needed.
急性肝衰竭（ALF）是一种罕见但危及生命的疾病，主要需要入住重症监护病房（ICU）。ALF 可引起免疫紊乱，并可能促进感染的发生。然而，其临床谱和对患者预后的影响仍未得到充分探索。
我们对 2000 年至 2021 年期间因 ALF 入住某转诊大学医院 ICU 的患者进行了一项回顾性单中心研究。分析了有无感染及感染发生时间直至第 28 天的患者的基线特征和结局。使用逻辑回归确定感染的危险因素。使用比例风险 Cox 模型评估感染对 28 天生存率的影响。
194 例患者中，79 例（40.7%）发生感染：社区获得性感染、入 ICU 前医院获得性感染和 ICU 前/后医院获得性感染以及移植前/后感染分别有 26、23、23 和 14 例患者。大多数感染为肺炎（41.4%）和血流感染（38.8%）。共鉴定出 130 种微生物，其中 55 种为革兰氏阴性杆菌（42.3%），48 种为革兰氏阳性球菌（36.9%），21 种为真菌（16.2%）。肥胖（OR 3.77 [95% CI 1.18-14.40]；=.03）和初始机械通气（OR 2.26 [95% CI 1.25-4.12]；=.007）是与总感染相关的独立因素。SAPSII > 37（OR 3.67 [95% CI 1.82-7.76]，<.001）和对乙酰氨基酚病因（OR 2.10 [95% CI 1.06-4.22]，=.03）与 ICU 入院时的感染独立相关。相反，对乙酰氨基酚病因与 ICU 获得性感染的风险降低相关（OR 0.37 [95% CI 0.16-0.81]，=.02）。任何类型感染的患者 28 天生存率均较低（57% vs. 73%；HR 1.65 [1.01-2.68]，=.04）。ICU 入院时存在感染（=.04），而非 ICU 获得性感染，与生存率降低相关。
ALF 患者感染发生率较高，且死亡风险增加。需要进一步研究评估早期抗菌治疗的应用。
