title: Renal failure and hyponatremia in patients with cirrhosis and skin and soft tissue infection. A retrospective study.
abstract: OBJECTIVE
  Skin and soft tissue infection in cirrhosis is considered a non-severe infection, but specific information is lacking. This study aimed at assessing the characteristics, occurrence of renal failure, and outcome of cirrhotic patients with skin and soft tissue infection.
  
  
  METHODS
  Ninety-two patients with cirrhosis and skin and soft tissue infection admitted to hospital within a 6-year period were retrospectively analyzed. A control group matched by severity of liver disease, admitted for reasons other than infection, was also studied.
  
  
  RESULTS
  Resolution of the infection was achieved in 96% of patients. Twenty (21.7%) patients with skin and soft tissue infection developed renal failure, compared to only five patients (5.4%) of the control group (p=0.001). Renal failure was persistent despite infection resolution in 10 of the 20 patients vs. none of the control group. Renal failure was associated with poor prognosis. Hyponatremia developed in 40% and 25% of the infection and control group, respectively (p=0.028). Within a 3-month follow-up period, 25 patients (23%) with skin and soft tissue infection died or were transplanted compared to only four patients (4%) of the control group (p<0.001). Factors independently associated with mortality in the infection group were: site of acquisition of the infection and MELD-sodium score at diagnosis.
  
  
  CONCLUSIONS
  Skin and soft tissue infection is a severe complication of cirrhosis with high frequency of renal failure and hyponatremia that may persist despite resolution of the infection. MELD-sodium score is useful to assess 3-month mortality in these patients.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofia de Investigación Nefrologia (IRSIN), Spain.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pereira
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofia de Investigación Nefrologia (IRSIN), Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Guevara
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofia de Investigación Nefrologia (IRSIN), Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fagundes
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofia de Investigación Nefrologia (IRSIN), Spain.
authors.forename: Elsa
authors.initials: E
authors.lastname: Solá
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofia de Investigación Nefrologia (IRSIN), Spain.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Rodríguez
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.affiliation: Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavesi
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofia de Investigación Nefrologia (IRSIN), Spain. Electronic address: pgines@clinic.ub.es.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D018461:Soft Tissue Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D015996:Survival Rate