Abstract | BACKGROUND & AIMS: METHODS: This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death. RESULTS: A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p <0.001). Spontaneous bacterial peritonitis, pneumonia or infections caused by extensively drug resistant (XDR) bacteria were more frequently associated with ACLF development. More patients with ACLF had a positive quick sequential organ failure assessment score and septic shock, resulting in a lower infection resolution rate (all p <0.001). CONCLUSIONS:
Bacterial infections, especially with XDR organisms, are associated with the highest risk of ACLF development, accounting for almost half of cases globally. Geographic differences result in variable epidemiology and clinical outcomes. LAY SUMMARY:
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Authors | Florence Wong, Salvatore Piano, Virendra Singh, Michele Bartoletti, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Elza Cotrim Soares, Dong Joon Kim, Sung Eun Kim, Monica Marino, Julio Vorobioff, Rita de Cassia Ribeiro Barea, Manuela Merli, Laure Elkrief, Victor Vargas, Aleksander Krag, Shivaram Prasad Singh, Laurentius Adrianto Lesmana, Claudio Toledo, Sebastian Marciano, Xavier Verhelst, Nicolas Intagliata, Liane Rabinowich, Luis Colombato, Sang Gyune Kim, Alexander Gerbes, Francois Durand, Juan Pablo Roblero, Tony Bruns, Eileen Laurel Yoon, Marcos Girala, Nikolaos T Pyrsopoulos, Tae Hun Kim, Sun Young Yim, Adria Juanola, Adrian Gadano, Paolo Angeli, International Club of Ascites Global Study Group |
Journal | Journal of hepatology
(J Hepatol)
Vol. 74
Issue 2
Pg. 330-339
(02 2021)
ISSN: 1600-0641 [Electronic] Netherlands |
PMID | 32781201
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2020. Published by Elsevier B.V. |
Topics |
- Acute-On-Chronic Liver Failure
(diagnosis, etiology, microbiology, mortality)
- Age Factors
- Alcohol-Related Disorders
- Bacterial Infections
(complications, diagnosis, epidemiology, microbiology)
- Community-Acquired Infections
(complications, diagnosis, epidemiology, microbiology)
- Cross Infection
(complications, diagnosis, epidemiology, microbiology)
- Europe
(epidemiology)
- Female
- Hospitalization
(statistics & numerical data)
- Humans
- India
(epidemiology)
- Male
- Middle Aged
- Organ Dysfunction Scores
- Prognosis
- Risk Assessment
- Severity of Illness Index
- Sex Factors
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