Short-term prognosis of community-acquired bacteremia in patients with liver cirrhosis or alcoholism: A population-based cohort study.
BACKGROUND
Liver cirrhosis is associated with an increased risk of infection and a poor prognosis, but the role of alcoholism in these outcomes is uncertain. This study looks at the short-term prognosis for bacteremia in patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism, compared with the prognosis for other bacteremia cases.


METHODS
All patients who were hospitalized with their first community-acquired bacteremia in North Jutland County, Denmark, in the period 1992 to 2002 were retrieved from a population-based bacteremia registry. Denmark's Hospital Discharge Registry then allowed us to disaggregate these patients into the following groups: 47 patients with alcoholic liver cirrhosis, 19 with nonalcoholic liver cirrhosis, 190 with alcoholism, and a comparison group of 3,535 other bacteremia cases. Using logistic regression, we estimated odds ratios (ORs) for 30-day case fatality for the main study variable, adjusted for gender, age, focus of infection, and comorbidity.


RESULTS
The case fatality rate (CFR) was 43% for patients with alcoholic liver cirrhosis, 32% for patients with nonalcoholic liver cirrhosis, 24% for patients with alcoholism, and 15% for other bacteremia patients. The adjusted OR estimates for patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism compared with other bacteremia cases were 6.3 (95% CI 3.3-11.7), 2.4 (95% CI 0.9-6.7), and 2.5 (95% CI 1.7-3.7), respectively. Focus of infection and group of bacteria did not noticeably affect the increased CFR.


CONCLUSIONS
Liver cirrhosis and alcoholism were associated with a poor short-term prognosis for community-acquired bacteremia. Liver cirrhosis and alcoholism may have independent effects on the prognosis for patients with liver cirrhosis and bacteremia.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. gl@dce.au.dk
Gitte
G
Linderoth
Peter
P
Jepsen
Henrik C
HC
Schønheyder
Søren Paaske
SP
Johnsen
Henrik Toft
HT
Sørensen
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications*; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis