title: Predictors of mortality among patients with compensated and decompensated liver cirrhosis: the role of bacterial infections and infection-related acute-on-chronic liver failure.
abstract: OBJECTIVE
  Population-based data on the impact of bacterial infections on the course of compensated and decompensated cirrhosis as well as the occurrence, predictors of infection-related acute-on-chronic liver failure (ACLF) and its fatal outcome are limited.
  
  
  METHODS
  All patients with incident cirrhosis in the period 2001-2010, residing in an area of 600,000 inhabitants, were retrospectively identified. All serious bacterial infections (resulting in or occurring during an inpatient hospital episode) during this period were analyzed. Infection site and acquisition type, comorbid illness (Charlson comorbidity index) and infection severity features were analyzed. Patients were followed up until death, transplant, or the end of 2011.
  
  
  RESULTS
  Overall, 398 serious bacterial infections occurred in 241/633 (38%) patients (106/332 diagnosed with compensated and 135/301 with decompensated disease; follow-up time was 2276 patient-years). ACLF occurred in 95/398 (24%) serious infections with an in-hospital mortality of 50%. In logistic regression analysis, the model for end-stage liver disease score, active alcohol misuse and healthcare-associated infections were predictors of infection-related ACLF (p < 0.05 for all). In-hospital mortality in infections with ACLF was related to albumin levels, Charlson comorbidity index >1 and occurrence of one or more organ failures (p > 0.05 for all). In Cox regression analysis, infection-related ACLF was an independent negative predictor of transplant-free survival in decompensated patients (p = 0.049).
  
  
  CONCLUSIONS
  In a population-based cirrhotic cohort, infection-related ACLF was a negative predictor of survival in decompensated disease. Infection-related ACLF was frequent and related to cirrhosis severity and infection acquisition type, as well as to high inpatient mortality, in particular in patients with significant comorbidity.
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, University of Lund , Lund , Sweden.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Sargenti
authors.forename: Hanne
authors.initials: H
authors.lastname: Prytz
authors.forename: Emma
authors.initials: E
authors.lastname: Nilsson
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000401:mortality*; D000368:Aged; D001424:Bacterial Infections / Q000145:classification* / Q000453:epidemiology*; D015897:Comorbidity; D003428:Cross Infection / Q000150:complications*; D058625:End Stage Liver Disease / Q000150:complications*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
keywords: acute-on-chronic liver failure; bacterial infection; comorbidity; compensated cirrhosis; decompensated cirrhosis; healthcare-associated infection; hospital-acquired infection; organ failure; prognosis