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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
Amoros, Alex
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
Pronòstic mèdic
Liver diseases
Chronic diseases
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:
It is part of: Gut, 2017, vol. 67, num. 10, p. 1870-1880
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ISSN: 0017-5749
Appears in Collections:Articles publicats en revistes (Medicina)

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