Predicting risk factors for rebleeding, infections, mortality following peptic ulcer bleeding in patients with cirrhosis and the impact of antibiotics prophylaxis at different clinical stages of the disease.
BACKGROUND
Infections in cirrhotic patients with upper gastrointestinal bleeding are a common event causing severe complication and mortality. This study aimed to identify risk factors that may predict rebleeding, bacterial infections, and the impact of antibiotic prophylaxis on mortality at different stages of cirrhosis following acute peptic ulcer bleeding (PUB).


METHODS
A hospital-based retrospective cohort study was conducted on 235 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures between January 2008 and January 2014 (n = 235); of these, 88 patients received prophylactic intravenous ceftriaxone (antibiotic group) and 147 patients did not (nil-antibiotic group). The recorded outcomes were length of hospital stay, bacterial infection, rebleeding, and in-hospital mortality.


RESULTS
Forty-eight (20.4%) patients experienced ulcer rebleeding and 46 (19.6%) developed bacterial infections. More patients suffered from infection and recurrent bleeding in the nil-antibiotic group than the antibiotic group (25.2% vs. 10.2%, p = 0.005 and 30.6% vs. 3.4%; p < 0.001, respectively). The predictive risk factors for rebleeding were the Rockall score (p = 0.004), units of blood transfusion (p = 0.031), and no antibiotic prophylaxis (p <0.001); for bacterial infections, they were the Child-Pugh score (p = 0.003), active alcoholism (p = 0.035), and no antibiotic prophylaxis (p = 0.009). Overall, 40 (17%) patients died during hospitalization. The Rockall score and rebleeding were predictive factors for in-hospital mortality. In subgroup analysis, survival was significantly reduced in decompensated patients (p = 0.034).


CONCLUSIONS
This study suggests that antibiotic prophylaxis after endoscopic hemostasis for acute PUB prevented infections and reduced rebleeding events in cirrhotic patients. Antibiotic prophylaxis improved survival among decompensated cohort following PUB. The Rockall score and rebleeding were predictive risk factors for in-hospital mortality.
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. b9005029@cgmh.org.tw.
Ming-Te
MT
Kuo
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. d5637700@adm.cgmh.org.tw.
Shih-Cheng
SC
Yang
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. llluuu@cgmh.org.tw.
Lung-Sheng
LS
Lu
Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University; College of Medicine, Kaohsiung, Taiwan. cnhsu@cgmh.org.tw.
Chien-Ning
CN
Hsu
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 0104kuo@pchome.com.tw.
Yuan-Hung
YH
Kuo
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. grantkuo1107@gmail.com.
Chung-Huang
CH
Kuo
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. gimy54861439@gmail.com.
Chih-Ming
CM
Liang
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. kuo51116@gmail.com.
Chung-Mou
CM
Kuo
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. aasavage.tw@yahoo.com.tw.
Cheng-Kun
CK
Wu
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. luketai1019@gmail.com.|Division of Hepatogastroenterology, Kaohsiung Chang Gang Memorial Hospital, 123 Ta-Pei Road, Niaosung Hsiang, Kaohsiung City, 833, Taiwan. luketai1019@gmail.com.
Wei-Chen
WC
Tai
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. chuahsk@seed.net.tw.|Division of Hepatogastroenterology, Kaohsiung Chang Gang Memorial Hospital, 123 Ta-Pei Road, Niaosung Hsiang, Kaohsiung City, 833, Taiwan. chuahsk@seed.net.tw.
Seng-Kee
SK
Chuah
D000368:Aged; D000437:Alcoholism / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000150:complications / Q000517:prevention & control*; D001803:Blood Transfusion; D002443:Ceftriaxone / Q000627:therapeutic use*; D005260:Female; D016558:Hemostasis, Endoscopic; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000517:prevention & control*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone