Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort).
To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis.



This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child-Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework.



1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control.



BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.
AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France.
Pierre
P
Nahon
AP-HP, Hôpital Jean Verdier, Service de Microbiologie, Bondy, Université Paris 13, Bobigny, et INSERM UMR 1139, Paris, France.
Mathilde
M
Lescat
AP-HP, Hôpital Henri Mondor, Département de Santé Publique, Créteil, France.
Richard
R
Layese
AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France.
Valérie
V
Bourcier
AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France.
Nabila
N
Talmat
Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France.
Setty
S
Allam
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Patrick
P
Marcellin
CHU Pontchaillou, Service d'Hépatologie, Rennes, France.
Dominique
D
Guyader
AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris, France.
Stanislas
S
Pol
Hôpital Saint Eloi, Service d'Hépatologie, Montpellier, France.
Dominique
D
Larrey
Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux, France.
Victor
V
De Lédinghen
Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France.
Denis
D
Ouzan
Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon, France.
Fabien
F
Zoulim
AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France.
Dominique
D
Roulot
CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France.
Albert
A
Tran
Hôpital Brabois, Service d'Hépatologie, Vandoeuvre-les-Nancy, France.
Jean-Pierre
JP
Bronowicki
Hôpital Michallon, Service d'Hépatologie, Grenoble, France.
Jean-Pierre
JP
Zarski
Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France.
Odile
O
Goria
CHU d'Angers, Service d'Hépatologie, Angers, France.
Paul
P
Calès
Hôpital Purpan, Service d'Hépatologie, Toulouse, France.
Jean-Marie
JM
Péron
CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France.
Laurent
L
Alric
Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France.
Marc
M
Bourlière
Hôpital Claude Huriez, Service d'Hépatologie, Lille, France.
Philippe
P
Mathurin
Hôpital St André, Service d'Hépatologie, Bordeaux, France.
Jean-Frédéric
JF
Blanc
Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France.
Armand
A
Abergel
AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France.
Lawrence
L
Serfaty
AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France.
Ariane
A
Mallat
AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris, France.
Jean-Didier
JD
Grangé
AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France.
Pierre
P
Attali
Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, Tours, France.
Yannick
Y
Bacq
Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France.
Claire
C
Wartelle
Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France.
Thông
T
Dao
AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France.
Yves
Y
Benhamou
CHU Le Mans, Service d'Hépatologie, Le Mans, France.
Christophe
C
Pilette
CHU de Poitiers, Service d'Hépatologie, Poitiers, France.
Christine
C
Silvain
Institut Mutualiste Montsouris, Service d'Hépatologie, Paris, France.
Christos
C
Christidis
Hôpital Amiens Nord, Service d'Hépatologie, Amiens, France.
Dominique
D
Capron
Hôpital Robert Debré, Service d'Hépatologie, Reims, France.
Brigitte
B
Bernard-Chabert
Hôpital Foch, Service d'Hépatologie, Suresnes, France.
Sophie
S
Hillaire
Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, France.
Vincent
V
Di Martino
AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France.
Jean-Claude
JC
Trinchet
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Richard
R
Moreau
AP-HP, Hôpital Henri Mondor, Département de Santé Publique, Créteil, France.
Françoise
F
Roudot-Thoraval
D000328:Adult; D001424:Bacterial Infections / Q000401:mortality*; D002423:Cause of Death; D060085:Coinfection / Q000401:mortality*; D005260:Female; D005602:France / Q000453:epidemiology; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000401:mortality* / Q000503:physiopathology* / Q000821:virology; D017093:Liver Failure / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000382:microbiology / Q000401:mortality; D011014:Pneumonia / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014552:Urinary Tract Infections / Q000401:mortality
BACTERIAL INFECTION; CIRRHOSIS; HEPATITIS B; HEPATITIS C