Kremer A, Rios B, Moreno N, Allevato J, Calanni L, Chiocconi E, Formaro A, Schmidt G, Kremer C
Servicio de Clínica Médica, Hospital Provincial Neuquen.
Acta Gastroenterol Latinoam. 1993;23(3):135-42.
We studied retrospectively the clinical records of 291 hospital patients with liver cirrhosis, 95% of which was alcohol related. Within this group, 114 patients presented 155 episodes of infection in 144 separate hospital admissions. In a previous communication, we pointed out that although infection was the fourth cause of admission, it was the main cause of death in this group. The main incidence of infection was among the female group. The most common infections episodes were respiratory and bacterial spontaneous peritonitis (BSP). On admission, 57% of the patients were diagnosed as belonging to the C Child group; 38% presented sepsis and 22% were hospitalary infections. The most frequent infections were respiratory and BSP. We obtained bacteriologic documentation in 55% of the episodes with prevalence of Gram negative bacilli (E. coli), with high relative frequency of neumoccocus. The most frequent complications were related to hepatic insufficiency. Global death rate was 27.1%, while nosocomial death rates were 42.1% and 40.9% for patients with Child C. We observed the highest incidence of mortality in patients with SBP and non localized bacteriemia. Survival rates were 42% for 2 years and 18% for 5 years. In summary, we stress the relevancy of checking the presence of infection systematically in every cirrhotic patient with encephalopathy and/or renal insufficiency without justifiable cause.
我们回顾性研究了291例肝硬化住院患者的临床记录,其中95%与酒精有关。在该组患者中,114例患者在144次单独住院期间出现了155次感染发作。在之前的一篇通讯中,我们指出,尽管感染是住院的第四大原因,但却是该组患者的主要死亡原因。感染的主要发生率在女性组中。最常见的感染发作是呼吸道感染和细菌性自发性腹膜炎(BSP)。入院时,57%的患者被诊断为C级儿童组;38%出现败血症,22%为医院感染。最常见的感染是呼吸道感染和BSP。我们在55%的发作中获得了细菌学记录,革兰氏阴性杆菌(大肠杆菌)占优势,肺炎球菌的相对频率较高。最常见的并发症与肝功能不全有关。总体死亡率为27.1%,而C级儿童患者的医院死亡率分别为42.1%和40.9%。我们观察到自发性腹膜炎和非局限性菌血症患者的死亡率最高。2年生存率为42%,5年生存率为18%。总之,我们强调对于每一位无合理原因出现脑病和/或肾功能不全的肝硬化患者,系统检查是否存在感染的相关性。