title: The effect of bacterial infections in cirrhotic patients with esophageal variceal bleeding.
abstract: BACKGROUND
  Cirrhotic patients are prone to having bacterial infections due to impaired innate immunity. This nationwide population-based study aimed to identify the effect of bacterial infections on the mortality of the cirrhotic patients with esophageal variceal bleeding (EVB).
  
  
  METHODS
  The Taiwan National Health Insurance Database was used to collect data about the cirrhotic patients receiving endoscopic procedures for EVB between January 1, 2004 and December 31, 2004. The enrolled patients were followed up individually for one year to identify their 6-week and 1-year mortalities.
  
  
  RESULTS
  Of the 2,053 cirrhotic patients with EVB, 318 (15.5 %) were diagnosed with bacterial infections. Compared to non-infection group, the adjusted hazard rations (HRs) of bacterial infection for 6-week and 1-year mortalities were 2.69 (2.06-3.52) and 1.89 (1.56-2.28), respectively. Compared to non-infection group, the HRs of pneumonia, spontaneous bacterial peritonitis, urinary tract infection, and sepsis without specific focus (SWSF) were 3.54, 1.91, 1.04, and 3.95 for 6-week mortality, and 3.18, 1.52, 1.15, and 2.23 for 1-year mortality of cirrhotic patients with EVB.
  
  
  CONCLUSIONS
  In cirrhotic patients with EVB, bacterial infections increase 2.7 folds of 6-week mortality and 1.9 folds of 1-year mortality. Of all infections, pneumonia and SWSF contributed higher risks for mortality.
authors.affiliation: Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien.
authors.forename: Gan
authors.initials: G
authors.lastname: Zuo-Hua
authors.affiliation: School of Medicine, Tzu Chi University, Hualien; Division of Infectious Disease, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
authors.forename: Tsai
authors.initials: T
authors.lastname: Chen-Chi
authors.affiliation: School of Medicine, Tzu Chi University, Hualien; Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
authors.forename: Tseng
authors.initials: T
authors.lastname: Kuo-Chih
authors.affiliation: Department of Mathematics, Tamkang University, Tamsui, Taiwan;
authors.forename: Tsai
authors.initials: T
authors.lastname: Chih-Chun
authors.affiliation: School of Medicine, Tzu Chi University, Hualien; Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
authors.forename: Hsieh
authors.initials: H
authors.lastname: Yu-Hsi
authors.affiliation: School of Medicine, Tzu Chi University, Hualien; Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
authors.forename: Hung
authors.initials: H
authors.lastname: Tsung-Hsing
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D004932:Esophageal and Gastric Varices / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010538:Peritonitis / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000453:epidemiology; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology