Clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease.
Bacterial infection is an important cause of death in patients with liver cirrhosis. The aim of this study was to investigate the clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease (ALD). We retrospectively analyzed data from 409 patients consecutively admitted to a tertiary referral center with ALD diagnosis. Of a total of 544 admissions, 133 (24.4%) cases presented with bacterial infection, of which 116 were community-acquired whereas 17 were hospital-acquired. The common types of infection were pneumonia (38%), biliary tract infection (17%), soft tissue infection (12%), and spontaneous bacterial peritonitis (9%). Diabetes, serum Na <135 mM/L, albumin <2.5 g/dL, C-reactive protein ≥20 mg/L, systemic inflammatory response syndrome (SIRS) positivity were independently associated with bacterial infection in patients with ALD. Overall 30-day and 90-day mortalities in patients with bacterial infection were significantly (P < 0.001) higher than those without infection (22.3% vs. 5.1% and 32.3% vs. 8.2%, respectively). Furthermore, bacterial infection (HR, 2.2; 95% CI, 1.049-4.579, P = 0.037), SIRS positivity (HR, 2.5; 95% CI, 1.240-4.861, P = 0.010), Maddrey's discriminant function score ≥32 (HR, 2.3; 95% CI, 1.036-5.222, P = 0.041), and hemoglobin <12 g/dL (HR, 2.4; 95% CI, 1.081-5.450, P = 0.032) were independent predictors of short-term mortality. In conclusion, bacterial infection and SIRS positivity predicted short-term prognosis in hospitalized patients with ALD. A thorough evaluation at admission or on clinical deterioration is required to detect possible infection with prompt management.
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Jin Kyoung
0000-0001-6544-4938
JK
Park
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Chang Hun
0000-0001-7244-8849
CH
Lee
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
In Hee
0000-0003-3863-7907
IH
Kim
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Seon Min
0000-0002-5553-6748
SM
Kim
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Ji Won
0000-0001-8565-991X
JW
Jang
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Seong Hun
0000-0002-7592-8060
SH
Kim
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Sang Wook
0000-0001-8209-540X
SW
Kim
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Seung Ok
0000-0003-0243-215X
SO
Lee
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Soo Teik
0000-0002-2975-053X
ST
Lee
Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
Dae-Ghon
0000-0002-4468-4323
DG
Kim
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D002097:C-Reactive Protein / Q000032:analysis; D002175:Candida / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010361:Patients; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012964:Sodium / Q000097:blood; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000175:diagnosis; D062606:Tertiary Care Centers
D006454:Hemoglobins; D012709:Serum Albumin; D002097:C-Reactive Protein; D012964:Sodium
Bacterial Infections; Liver Disease, Alcoholic; Prognosis