Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features.
The aim of the study was to investigate the prevalence and clinical course of renal failure that was induced by the various types of bacterial infections in patients with cirrhosis and ascites. Three hundred and nine patients, who were consecutively admitted to the 3 major hospitals of Padova, Italy, during the first 6 months of 2005, were studied prospectively. Of these, 233 patients (75.4%) had evidence of ascites. In 104 patients with cirrhosis and ascites (44.6%) a bacterial infection was diagnosed. A bacterial infection-induced renal failure was observed in 35 of 104 patients (33.6%). The prevalence of renal failure was higher in biliary or gastrointestinal tract infections and in spontaneous bacterial peritonitis (SBP) and in than in other types of infections. In addition, the progressive form of renal failure was only precipitated by biliary or gastrointestinal tract infections, SBP, and urinary tract infections (UTI). In a multivariate analysis only MELD score (P = 0.001), the peak count of neutrophil leukocyte in blood (P = 0.04), and the lack of resolution of infection (P = 0.03) had an independent predictive value on the occurrence of renal failure.


CONCLUSIONS
The results of the study show that the development of bacterial-induced renal failure in patients with cirrhosis and ascites is related to the MELD score, and to both the severity and the lack of resolution of the infection. A progressive form of renal failure occurs only as a consequence of biliary or gastrointestinal tract infections, SBP, and UTI.
Fasolato
Silvano
S
Department of Clinical and Experimental Medicine, General Hospital and University of Padova, Padova, Italy.
Angeli
Paolo
P
Dallagnese
Lucia
L
Maresio
Giulio
G
Zola
Erika
E
Mazza
Elena
E
Salinas
Freddy
F
Donà
Silvio
S
Fagiuoli
Stefano
S
Sticca
Antonietta
A
Zanus
Giacomo
G
Cillo
Umberto
U
Frasson
Ilaria
I
Destro
Carla
C
Gatta
Angelo
A
D000368:Aged; D001201:Ascites / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D001424:Bacterial Infections / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000382:microbiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D012720:Severity of Illness Index; D015996:Survival Rate; D014552:Urinary Tract Infections / Q000150:complications / Q000382:microbiology