title: A multicenter prospective study of infections related morbidity and mortality in cirrhosis of liver.
abstract: OBJECTIVE
  Infections are a common and serious complication among patients with cirrhosis. We assessed the epidemiology, risk factors, and clinical consequences of bacterial infections in cirrhotic patients.
  
  
  METHODS
  In this multicenter prospective study, all patients with cirrhosis of liver with different infections were analyzed. Infections were classified as community-acquired (CA), healthcare-associated (HCA), or hospital-acquired (HA). Site of infection and characteristics of bacteria were recorded; effect on liver function and 30-day survival were evaluated.
  
  
  RESULTS
  One hundred and six out of 420 (25 %) patients with cirrhosis of liver had infection. Infection rate among indoor patients was 37.5 % (92/245) and among outdoor patients was 8 % (14/175). Out of 106 patients, CA, HCA, and HA were seen in 19.8 %, 50 %, and 30.2 %, respectively. Spontaneous bacterial peritonitis (31.1 %), urinary tract infections (22.6 %), and pneumonia and cellulitis (11.3 % each) were common infections. Gram-negative bacteria (54 %) were more common than Gram-positive cocci (46 %). Multidrug resistant (MDR) organisms were seen in 41.7 % of patients. Most of the MDR organisms were seen in HCA and HA patients. The degree of liver impairment was significantly more severe in patients with infection. Independent predictor of infection was high Child-Turcott-Pugh (CTP) class (p = 0.006, Child B vs. A (odds ratio (OR) 3.04 95 % CI = 1.63 to 5.68) and Child C vs. A (OR 4.17 95 % CI = 2.12 to 8.19). Overall in-hospital mortality was 7.6 %. Patients with infection had increased mortality at 30-day follow up compared to those without infection (23.5 % vs. 2.2 %; p<0.001).
  
  
  CONCLUSIONS
  Infections are one of the important causes of morbidity and mortality in patients with cirrhosis of liver. The most frequent infections are HCA and HA. Infection predisposes to deterioration of liver function and increases mortality. Cirrhotic patients should be monitored closely for infections especially those with Child class B and C.
authors.affiliation: Department of Gastroenterology, Jagjivan Ram Hospital, Maratha Mandir Marg, Mumbai Central, Mumbai, 400 008, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Baijal
authors.forename: Deepak
authors.initials: D
authors.lastname: Amarapurkar
authors.forename: H R
authors.initials: HR
authors.lastname: Praveen Kumar
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Nimish
authors.initials: N
authors.lastname: Shah
authors.forename: Soham
authors.initials: S
authors.lastname: Doshi
authors.forename: Deepak
authors.initials: D
authors.lastname: Gupta
authors.forename: Mayank
authors.initials: M
authors.lastname: Jain
authors.forename: Nikhil
authors.initials: N
authors.lastname: Patel
authors.forename: Praful
authors.initials: P
authors.lastname: Kamani
authors.forename: S K
authors.initials: SK
authors.lastname: Issar
authors.forename: Mrudul
authors.initials: M
authors.lastname: Dharod
authors.forename: Apoorva
authors.initials: A
authors.lastname: Shah
authors.forename: Madhuri
authors.initials: M
authors.lastname: Chandnani
authors.forename: Sonali
authors.initials: S
authors.lastname: Gautam
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications* / Q000401:mortality*; D017714:Community-Acquired Infections / Q000150:complications* / Q000401:mortality*; D003428:Cross Infection / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors