title: High mortality of pneumonia in cirrhotic patients with ascites.
abstract: BACKGROUND
  Cirrhotic patients with ascites are prone to develop various infectious diseases. This study aimed to evaluate the occurrence and effect of major infectious diseases on the mortality of cirrhotic patients with ascites.
  
  
  METHODS
  We reviewed de-identified patient data from the National Health Insurance Database, derived from the Taiwan National Health Insurance Program, to enroll 4,576 cirrhotic patients with ascites, who were discharged from Taiwan hospitals between January 1, 2004 and June 30, 2004. We collected patients' demographic and clinical data, and reviewed diagnostic codes to determine infectious diseases and comorbid disorders of their hospitalizations. Patients were divided into an infection group and non-infection group and hazard ratios (HR) were determined for specific infectious diseases.
  
  
  RESULTS
  Of the total 4,576 cirrhotic patients with ascites, 1,294 (28.2%) were diagnosed with infectious diseases during hospitalization. The major infectious diseases were spontaneous bacterial peritonitis (SBP) (645, 49.8%), urinary tract infection (151, 11.7%), and pneumonia (100, 7.7%). After adjusting for patients' age, gender, and other comorbid disorders, the HRs of infectious diseases for 30-day and 90-day mortality of cirrhotic patients with ascites were 1.81 (1.54-2.11) and 1.60 (1.43-1.80) respectively, compared to those in the non-infection group. The adjusted HRs of pneumonia, urinary tract infection (UTI), spontaneous bacterial peritonitis (SBP), and sepsis without specific focus (SWSF) were 2.95 (2.05-4.25), 1.32 (0.86-2.05), 1.77 (1.45-2.17), and 2.19 (1.62-2.96) for 30-day mortality, and 2.57 (1.93-3.42), 1.36 (1.01-1.82), 1.51 (1.29-1.75), and 2.13 (1.70-2.66) for 90-day mortality, compared to those in the non-infection group.
  
  
  CONCLUSIONS
  Infectious diseases increased 30-day and 90-day mortality of cirrhotic patients with ascites. Among all infectious diseases identified, pneumonia carried the highest risk for mortality.
authors: Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan.
authors: Tsung-Hsing
authors: TH
authors: Hung
authors: Chih-Wei
authors: CW
authors: Tseng
authors: Yu-Hsi
authors: YH
authors: Hsieh
authors: Kuo-Chih
authors: KC
authors: Tseng
authors: Chih-Chun
authors: CC
authors: Tsai
authors: Chen-Chi
authors: CC
authors: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000453:epidemiology* / Q000401:mortality*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology / Q000401:mortality; D011014:Pneumonia / Q000453:epidemiology* / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000401:mortality
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