Bacterial infections associated with hepatic encephalopathy: prevalence and outcome.
Hepatic encephalopathy (HE) is a major sign of severe liver disease and the impact of associated bacterial infections should be better evaluated. A retrospective cohort of 333 patients with cirrhosis and HE was analyzed in three periods of time, from 1984 to 1998. Variance analysis, Wilcoxon, Chi-square and Fisher's exact tests were used for statistical comparisons. Prevalence of bacterial infections decreased along the time (p = 0.0029). Spontaneous Bacterial Peritonitis -SBP- (37%) and urinary tract infection (30%) were the more frequent types of bacterial infections. Early death was significantly higher in HE with infection (46,47%) and the calculated RR was 2.047. Prognosis was worse in septicemia (79%) and respiratory tract infection (50%) and better in urinary tract infection (27%). SBP lethality was reduced from 70% to 38% (p = 0.062). In conclusion, lower prevalence of bacterial infections, in severe liver disease, was achieved in the last decade, but short-term prognosis remains bad, varying according to the type of bacterial infection.
Strauss
Edna
E
Clinic of Gastroenterology, Heliopólis Hospital; School of Medicine-University of Säo Paulo, Av. Dr. Eneas de CArvalho Aguiar, 177-10o andar, CEP: 05403-000 Säo Paulo, Brazil. edna.strauss@hcnet.usp.br
Gomes de Sá Ribeiro
Maria de Fátima
Mde F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000382:microbiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000382:microbiology; D015995:Prevalence; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000150:complications / Q000382:microbiology; D012720:Severity of Illness Index; D014552:Urinary Tract Infections / Q000150:complications / Q000382:microbiology