High mortality of pneumonia in cirrhotic patients with ascites

BMC Gastroenterology

Chen-Chi Tsai²  Chih-Chun Tsai¹  Kuo-Chih Tseng³  Yu-Hsi Hsieh³  Chih-Wei Tseng³  Tsung-Hsing Hung³ 

[1] Department of Mathematics, Tamkang University, Tamsui, Taiwan;Division of Infectious disease, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan;School of Medicine, Tzu Chi University, Hualien, Taiwan

关键词: Spontaneous bacterial peritonitis;    Pneumonia;    Infections;    Ascites;    Cirrhosis;   

Others  :  858192
DOI  :  10.1186/1471-230X-13-25

 received in 2012-07-01, accepted in 2013-01-28,  发布年份 2013

【 摘 要 】

Background

Cirrhotic patients with ascites are prone to develop various infectious diseases. This study aimed to evaluate the occurrence and effect of major infectious diseases on the mortality of cirrhotic patients with ascites.

Methods

We reviewed de-identified patient data from the National Health Insurance Database, derived from the Taiwan National Health Insurance Program, to enroll 4,576 cirrhotic patients with ascites, who were discharged from Taiwan hospitals between January 1, 2004 and June 30, 2004. We collected patients’ demographic and clinical data, and reviewed diagnostic codes to determine infectious diseases and comorbid disorders of their hospitalizations. Patients were divided into an infection group and non-infection group and hazard ratios (HR) were determined for specific infectious diseases.

Results

Of the total 4,576 cirrhotic patients with ascites, 1,294 (28.2%) were diagnosed with infectious diseases during hospitalization. The major infectious diseases were spontaneous bacterial peritonitis (SBP) (645, 49.8%), urinary tract infection (151, 11.7%), and pneumonia (100, 7.7%). After adjusting for patients’ age, gender, and other comorbid disorders, the HRs of infectious diseases for 30-day and 90-day mortality of cirrhotic patients with ascites were 1.81 (1.54-2.11) and 1.60 (1.43-1.80) respectively, compared to those in the non-infection group. The adjusted HRs of pneumonia, urinary tract infection (UTI), spontaneous bacterial peritonitis (SBP), and sepsis without specific focus (SWSF) were 2.95 (2.05-4.25), 1.32 (0.86-2.05), 1.77 (1.45-2.17), and 2.19 (1.62-2.96) for 30-day mortality, and 2.57 (1.93-3.42), 1.36 (1.01-1.82), 1.51 (1.29-1.75), and 2.13 (1.70-2.66) for 90-day mortality, compared to those in the non-infection group.

Conclusion

Infectious diseases increased 30-day and 90-day mortality of cirrhotic patients with ascites. Among all infectious diseases identified, pneumonia carried the highest risk for mortality.

【 授权许可】

   
2013 Hung et al; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Christou L, Pappas G, Falagas ME: Bacterial infection-related morbidity and mortality in cirrhosis. Am J Gastroenterol 2007, 102:1510-1517.
• [2]Bonnel AR, Bunchorntavakul C, Reddy KR: Immune dysfunction and infections in patients with cirrhosis. Clin Gastroenterol Hepatol 2011, 9:727-738.
• [3]Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, Rodés J: Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002, 35:140-148.
• [4]Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, Boccia S, Colloredo-Mels G, Corigliano P, Fornaciari G, Marenco G, Pistarà R, Salvagnini M, Sangiovanni A: Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis 2001, 33:41-48.
• [5]Caly WR, Strauss E: A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993, 18:353-358.
• [6]Arvaniti V, D’Amico G, Fede G, Manousou P, Tsochatzis E, Plequezuelo M, Burroughs AK: Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010, 139:1246-1256.
• [7]Runyon BA: Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterology 1986, 91:1343-1346.
• [8]Pinzello G, Simonetti RG, Craxi A, Di Piazza S, Spanò C, Pagliaro L: Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic cirrhotic patients. Hepatology 1983, 3:545-549.
• [9]Tandon P, Garcia-Tsao G: Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis 2008, 28:26-42.
• [10]Tandon P, Garcia-Tsao G: Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol 2011, 9:260-265.
• [11]Viasus D, Garcia-Vidal C, Castellote J, Adamuz J, Verdaquer R, Dorca J, Manresa F, Gudio F, Carratalà J: Community-acquired pneumonia in patients with liver cirrhosis: clinical features, outcomes, and usefulness of severity scores. Medicine 2011, 90:110-118.
• [12]Wu CY, Kuo KN, Wu MS, Chen YJ, Wang CB, Lin JT: Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease. Gastroenterology 2009, 137:1641-1648.
• [13]Hung TH, Hsieh YH, Tsai CC, Tseng KC, Tsai CC: Is liver cirrhosis a risk factor for osteonecrosis of the femoral head in adults? A population-based 3-year follow-up study. Intern Med 2011, 50:2563-2568.
• [14]Hung TH, Tsai CC, Hsieh YH, Tsai CC, Tseng CW, Tsai JJ: Effect of renal impairment on mortality of patients with cirrhosis and spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol 2012, 10:677-681.
• [15]Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003, 348:1546-1554.
• [16]Thuluvath PJ, Morss S, Thompson R: Spontaneous bacterial peritonitis–in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol 2001, 96:1232-1236.
• [17]Ko CW, Kelley K, Meyer KE: Physician specialty and the outcomes and cost of admissions for end-stage liver disease. Am J Gastroenterol 2001, 96:3411-3418.
• [18]Wu CY, Wu MS, Kuo KN, Wang CB, Chen YJ, Lin JT: Long-term peptic ulcer rebleeding risk estimation in patients undergoing haemodialysis: a 10-year nationwide cohort study. Gut 2011, 60:1038-1042.
• [19]Kang CI, Song JH, Ko KS, Chung DR, Peck KR, Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study Group: Clinical significance of Staphylococcus aureus infection in patients with chronic liver diseases. Liver Int 2010, 30:1333-1338.
• [20]Cheruvattath R, Balan V: Infections in patients with end-stage liver disease. J Clin Gastroenterol 2007, 41:403-411.
• [21]Propst-Graham KL, Preheim LC, Vander Top EA, Snitily MU, Gentry-Nielsen MJ: Cirrhosis-induced defects in innate pulmonary defenses against Streptococcus pneumoniae. BMC Microbiol 2007, 7:94. BioMed Central Full Text
• [22]Ono Y, Watanabe T, Matsumoto K, Ito T, Kunii O, Goldstein E: Opsonophagocytic dysfunction in patients with liver cirrhosis and low responses to tumor necrosis factor-alpha and lipopolysaccharide in patients’ blood. J Infect Chemother 2004, 10:200-207.
• [23]Eddens T, Kolls JK: Host defenses against bacterial lower respiratory tract infection. Curr Opin Immunol 2012, 24:424-430.
• [24]Gentry MJ, Snitily MU, Preheim LC: Phagocytosis of Streptococcus pneumonia measured in vitro and in vivo in a rat model of carbon tetrachloride-induced liver cirrhosis. J Infect Dis 1995, 171:350-355.
• [25]Mueller-Ortiz SL, Drouin SM, Wetsel RA: The alternative activation pathway and complement component C3 are critical for a protective immune response against Pseudomonas aeruginosa in a murine model of pneumonia. Infect Immun 2004, 72:2899-2906.
• [26]Duchini A, Viernes ME, Nyberg LM, Hendry RM, Pockros PJ: Hepatic decompensation in patients with cirrhosis during infection with influenza A. Arch Intern Med 2000, 160:113-115.
• [27]Marzano A, Marengo A, Ruggiero T, Allice T, Sanna C, Alessandria C, Morgando A, Sciandrello MC, Franzin AM, Rizzetto M, Ghisetti V: Clinical impact of A/H1/N1/09 influenza in patients with cirrhosis: experience from a nosocomial cluster of infection. J Med Virol 2013, 85:1-7.
• [28]Benson AB, Burton JR Jr, Austin GL, Biggins SW, Zimmerman MA, Kam I, Mandell S, Silliman CC, Rosen H, Moss M: Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation. Liver Transpl 2011, 17:149-158.
• [29]D’Amico G, Garcia-Tsao G, Pagliaro L: Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006, 44:217-231.
• [30]Abdel-Khalek EE, El-Fakhry A, Helaly M, Hamed M, Elbaz O: Systemic inflammatory response syndrome in patients with liver cirrhosis. Arab J Gastroenterol 2011, 12:173-177.