Community- or Healthcare-Associated Bacterial Infections Increase Long-Term Mortality in Patients With Acute Decompensation of Cirrhosis

Am J Med Sci. 2018 Feb;355(2):132-139. doi: 10.1016/j.amjms.2017.08.003. Epub 2017 Aug 3.


Background: The aim of the present study was to determine the specific role of different types of bacterial infections (BIs) on the prognosis of cirrhotic patients with acute decompensation (AD).

Methods: We performed a prospective, observational cohort study consisting of 492 cirrhotic patients with AD at our center from February 2014 to March 2015. Clinical, laboratory and survival data were collected. The relationship between BIs and mortality was analyzed.

Results: BIs were identified in 157 of 492 patients at the time of admission or during the hospital stay. Among the patients, 65 had community-acquired (CA) or healthcare-associated (HCA) BIs, 54 developed hospital-acquired (HA) BIs, and 38 had CA/HCA with HA BIs. Patients with CA/HCA BIs had higher 90-day, 1-year and 2-year mortality rates (29.2%, 44.6% and 52.3%, respectively) and CA/HCA BIs remained an independent risk factor for long-term mortality on multivariate analysis (1 year: hazard ratio = 1.60; 95% CI: 1.07-2.41; P = 0.023 and 2 year: hazard ratio = 1.54; 95% CI: 1.05-2.25; P = 0.026). In contrast, patients with HA BIs had a higher 28-day mortality rate than patients with CA/HCA BIs. Logistic regression analysis showed previous ascites and prior BIs within 3 months were independent risk factors for CA/HCA BIs, whereas invasive minor surgical procedures with acute-on-chronic liver failure throughout the hospital stay and high chronic liver failure-sequential organ failure assessment scores were associated with nosocomial BIs.

Conclusions: CA/HCA BIs were associated with increased long-term mortality in cirrhotic patients with AD, whereas nosocomial BIs may be related to poor short-term prognosis.

Keywords: Community-acquired infection; Healthcare-associated infections; Hospital infection; Liver cirrhosis; Mortality.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Bacterial Infections / etiology
  • Bacterial Infections / mortality*
  • Bacterial Infections / therapy
  • Communicable Diseases / etiology
  • Communicable Diseases / mortality*
  • Communicable Diseases / therapy
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Hospital Mortality*
  • Humans
  • Iatrogenic Disease
  • Length of Stay
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / mortality*
  • Liver Cirrhosis / therapy
  • Liver Failure, Acute / mortality*
  • Liver Failure, Acute / therapy
  • Male
  • Middle Aged
  • Risk Factors
  • Survival Rate

Associated data

  • ChiCTR/ChiCTR-OCH-14005018