Long-term prognosis of cirrhotics with an upper gastrointestinal bleeding episode: does infection play a role?
OBJECTIVE
We evaluated the effect of infection on the short- and long-term outcome of cirrhotic patients with upper gastrointestinal bleeding (UGIB), in a series of patients not submitted to antibiotic prophylaxis.


METHODS
The cirrhotic patients hospitalized for UGIB were prospectively followed up until the last visit, death, or transplantation. A standard screening protocol was used for bacterial infection at admission.


RESULTS
In total, 205 patients were included in the study. Antibiotics were administered in 79 (38.5%) patients and an infection was documented in 64 (31.4%) patients. In total, 130 (63.4%) patients died after a mean (SD) follow up of 23.8 (30.9) months. Six-week mortality was higher in the infected patients (P < 0.0001). The mortality of patients who were alive 6 weeks after admission was not different between the infected and non-infected patients. Antibiotic use or bacterial infection, the Child-Pugh score, hepatocellular carcinoma, and creatinine were the independent predictors of 6-week mortality. Age and the Child-Pugh score were the only predictors of mortality of the patients who had survived for more than 6 weeks after acute bleeding. In total, 51 (24.9%) patients rebled, 37 (18.1%) within 5 days of admission. Rebleeding was more frequent (41.8% vs 14.3%, P < 0.0001) in infected patients, mostly due to differences in early rebleeding (31.6% vs 9.5%, P = 0.0001).


CONCLUSIONS
Bacterial infection is associated with failure to control UGIB and early mortality in cirrhotic patients, but does not seem to affect the outcome of patients who overcome the bleeding episode.
Vlachogiannakos
Jiannis
J
Second Department of Gastroenterology, Evangelismos Hospital, Athens Greece. jvlachog@hotmail.com
Sklavos
Pantelis
P
Viazis
Nikos
N
Manolakopoulos
Spilios
S
Markoglou
Costas
C
Kougioumtzian
Anastasios
A
Triantos
Christos
C
Theodoropoulos
Jiannis
J
Raptis
Sotirios
S
Karamanolis
Dimitrios G
DG
D000368:Aged; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis