title: Prognostic significance of infections in critically ill adult patients with acute liver injury: a retrospective cohort study.
abstract: Patients with acute liver failure have high rates of infections, likely from defects in immune function. Whether infections are independently associated with poor outcomes is unclear. We hypothesized that patients with acute liver injury who developed infections were at increased risk of adverse outcomes.
  
  
  
  We conducted a retrospective analysis of 150 critically ill adult patients admitted with acute liver dysfunction at a single academic institution between 2005 and 2011. We excluded patients with immunocompromised states, patients with chronic liver disease and patients who died or were discharged within 48 h of admission. Our primary endpoint was a 30-day event-free survival, with events defined as either death or liver transplantation. Our secondary endpoint was length of stay. Univariate and multivariate analyses were performed to determine associations between presence of infection and our primary and secondary endpoints.
  
  
  
  Of our cohort of 150 patients, 62 (41%) were infected and 88 (59%) were not infected. Of the infected patients, 45% died or underwent transplantation, compared to 22% for the non-infected patients (P = 0.003). Univariate and multivariate analyses demonstrated that infections in patients with acute liver dysfunction were an independent predictor of poor outcome (i.e. death or transplantation). In addition, specific types of infection, including pneumonia, independently led to a 48% increase in length of stay (P = 0.002).
  
  
  
  Infections in patients with acute liver dysfunction are associated with increased risk of death or transplant and increased hospital length of stay.
authors.affiliation: Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Zider
authors.affiliation: Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Radhika
authors.initials: R
authors.lastname: Zopey
authors.affiliation: Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Ronak
authors.initials: R
authors.lastname: Garg
authors.affiliation: Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Wang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Tisha S
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Deng
mesh_terms: D000328:Adult; D002140:California; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000145:classification*; D007362:Intensive Care Units; D007902:Length of Stay; D017114:Liver Failure, Acute / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors
keywords: acute liver failure; infection; length of stay; mortality; orthotopic liver transplantation