MELD-Na Is More Strongly Associated with Risk of Infection and Outcomes Than Other Characteristics of Patients with Cirrhosis

Dig Dis Sci. 2021 Jan;66(1):247-256. doi: 10.1007/s10620-020-06164-y. Epub 2020 Feb 25.

Abstract

Background and aims: The nature and outcomes of infection among patients with cirrhosis in safety-net hospitals are not well described. We aimed to characterize the rate of and risk factors for infection, both present on admission and nosocomial, in this unique population. We hypothesized that infections would be associated with adverse outcomes such as short-term mortality.

Methods: We used descriptive statistics to characterize infections within a retrospective cohort characterized previously. We used multivariable logistic regression models to assess potential risk factors for infection and associations with key outcomes such as short-term mortality and length of stay.

Results: The study cohort of 1112 patients included 33% women with a mean age of 56 ± 10 years. Infections were common (20%), with respiratory and urinary tract infections the most frequent. We did not observe a difference in the incidence of infection on admission based on patient demographic factors such as race/ethnicity or estimated household income. Infections on admission were associated with greater short-term mortality (12% vs 4% in-hospital and 14% vs 7% 30-day), longer length of stay (6 vs 3 days), intensive care unit admission (28% vs 18%), and acute-on-chronic liver failure (10% vs 2%) (p < 0.01 for all). Nosocomial infections were relatively uncommon (4%), but more frequent among patients admitted to the intensive care unit. Antibiotic resistance was common (38%), but not associated with negative outcomes.

Conclusion: We did not identify demographic risk factors for infection, but did confirm its morbid effect among patients with cirrhosis in safety-net hospitals.

Keywords: Acute-on-chronic liver failure; Cirrhosis; Disparities; Infection; Safety-net.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Cohort Studies
  • Communicable Diseases / diagnosis
  • Communicable Diseases / drug therapy
  • Communicable Diseases / epidemiology*
  • Cross Infection / diagnosis
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Drug Resistance, Multiple, Bacterial / physiology
  • End Stage Liver Disease / diagnosis
  • End Stage Liver Disease / drug therapy
  • End Stage Liver Disease / epidemiology*
  • Female
  • Hospital Mortality / trends
  • Hospitals, Urban / trends
  • Humans
  • Length of Stay / trends*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / epidemiology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Safety-net Providers / trends*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents