Bacterial infections increase morbidity and mortality in
cirrhosis. Our aim was to investigate whether in
alcoholic hepatitis the development of
bacterial infections was also a poor prognostic factor. In the retrospective evaluation of 681 hospitalized patients with
liver disease, from a single center during a six-year period, 52 (7.5%) cases of
alcoholic hepatitis were well documented, 73.1% by liver biopsy with histopathological analysis and the others by well characterized clinical-biochemical data. Males were predominant (ratio 3.3:1.0), mean age of 40 years and mean alcohol intake of 193 g/day. Major complications were:
Hepatic encephalopathy (n=5),
renal insufficiency (n=4) and digestive
bleeding (n=3).
Bacterial infections were found in 11 (21%) patients, distributed into: pulmonary (n=5), spontaneous bacterial
peritonitis (n=2), urinary (n=3) and dermatological (n=1). Early hospital death occurred in eight (15.4%) patients and comparative analysis between these and those who survived showed that poor prognostic factors were: presence of
hepatic encephalopathy (p=0.012), total
bilirubin > 20 mg% (p=0.012) and the presence of severe
infections (pulmonary and spontaneous bacterial
peritonitis) with statistical significance (p=0.004). In conclusion we have demonstrated that severe
bacterial infections are poor prognostic factors for
alcoholic hepatitis. Our recommendation, based on prophylaxis with
antibiotics during digestive
bleeding in
cirrhosis and in acute
hepatic insufficiency, is to extend this prophylaxis to
alcoholic hepatitis, in its severe form, in order to prevent
bacterial infections and early death.