Please use this identifier to cite or link to this item:
http://hdl.handle.net/2445/137838
Title: | Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis |
Author: | Fernández, Javier Acevedo, Juan Wiest, Reiner Gustot, Thierry Amorós, Àlex Deulofeu, Carme Reverter, Enric Martínez González, Javier Saliba, Faouzi Jalan, Rajiv Welzel, Tania Mara Pavesi, Marco Hernández Tejero, María Ginès i Gibert, Pere Arroyo, Vicente European Foundation for the Study of Chronic Liver Failure |
Keywords: | Malalties del fetge Malalties cròniques Infeccions Pronòstic mèdic Liver diseases Chronic diseases Infections Prognosis |
Issue Date: | 28-Aug-2017 |
Publisher: | BMJ Publishing Group |
Abstract: | Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival. Patients 407 patients with ACLF and 235 patients with acute decompensation (AD). Results 152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%). Conclusion Bacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies. |
Note: | Versió postprint del document publicat a: https://doi.org/10.1136/gutjnl-2017-314240 |
It is part of: | Gut, 2017, vol. 67, num. 10, p. 1870-1880 |
URI: | http://hdl.handle.net/2445/137838 |
Related resource: | https://doi.org/10.1136/gutjnl-2017-314240 |
ISSN: | 0017-5749 |
Appears in Collections: | Articles publicats en revistes (Medicina) |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
674285.pdf | 734.96 kB | Adobe PDF | View/Open |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.