title: Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study.
abstract: BACKGROUND
  Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis.
  
  
  OBJECTIVE
  We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients.
  
  
  METHODS
  We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation.
  
  
  RESULTS
  The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05).
  
  
  CONCLUSIONS
  Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.
authors.affiliation: Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustot
authors.forename: Peter
authors.initials: P
authors.lastname: Felleiter
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Velissaris
authors.forename: Charalampos
authors.initials: C
authors.lastname: Pierrakos
authors.forename: Fabio S
authors.initials: FS
authors.lastname: Taccone
authors.forename: Pavel
authors.initials: P
authors.lastname: Sevcik
authors.forename: Christophe
authors.initials: C
authors.lastname: Moreno
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000368:Aged; D016638:Critical Illness; D005260:Female; D006094:Gram-Positive Bacteria; D006801:Humans; D007239:Infections / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D018709:Statistics, Nonparametric
keywords: cirrhosis; infection; mortality; organ failure