Infections in Patients With Cirrhosis Increase Mortality Four-Fold and Should Be Used in Determining Prognosis
Infections in Patients With Cirrhosis Increase Mortality Four-Fold and Should Be Used in Determining Prognosis
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DOI：
10.1053/j.gastro.2010.06.019
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发表时间：
2010-10-01
期刊：
影响因子：
29.4
通讯作者：
Burroughs, Andrew Kenneth
中科院分区：
文献类型：
--
作者：
Arvaniti, Vasiliki;D'Amico, Gennaro;Burroughs, Andrew Kenneth
背景与目的：基于静脉曲张、腹水和出血的肝硬化分期预后模型已被提出。我们分析了肝硬化患者的感染数据，以确定它是否也是一个预后因素。方法：通过MEDLINE、EMBASE、科克伦和ISI Web of Science检索（1978-2009）识别研究;检索词包括脓毒症、感染、死亡率和肝硬化。评价了报告超过10例患者和死亡率数据的研究（n = 178）（225个队列，11，987例患者）。比较1、3和12个月后的死亡率与严重程度、部位、感染的微生物原因、肝硬化病因和发表年份。比较感染组与非感染组（18个队列，2317例患者）的合并死亡优势比。结果：感染患者的总体中位死亡率为38%：1个月为30.3%，12个月为63%。感染与非感染患者死亡的合并优势比为3.75（95%置信区间，2.12-4.23）。在101项报告自发性细菌性腹膜炎的研究（7062例患者）中，中位死亡率为43.7%：1个月时为31.5%，12个月时为66.2%。在30项报告菌血症的研究（1437例患者）中，中位死亡率为42.2%。2000年前的死亡率为47.7%，2000年后为32.3%（P = 0.023）;仅在自发性细菌性腹膜炎后30天死亡率降低（49% vs 31.5%; P = 0.005）。结论：在肝硬化患者中，感染使死亡率增加4倍; 30%的患者在感染后1个月内死亡，另外30%在1年内死亡。需要进行长期随访评价的前瞻性研究，以评估预防策略。
BACKGROUND & AIMS: A staged prognostic model of cirrhosis based on varices, ascites, and bleeding has been proposed. We analyzed data on infections in patients with cirrhosis to determine whether it is also a prognostic factor. METHODS: Studies were identified by MEDLINE, EMBASE, COCHRANE, and ISI Web of Science searches (1978-2009); search terms included sepsis, infection, mortality, and cirrhosis. Studies (n = 178) reporting more than 10 patients and mortality data were evaluated (225 cohorts, 11,987 patients). Mortality after 1, 3, and 12 months was compared with severity, site, microbial cause of infection, etiology of cirrhosis, and publication year. Pooled odds ratio of death was compared for infected versus noninfected groups (18 cohorts, 2317 patients). RESULTS: Overall median mortality of infected patients was 38%: 30.3% at 1 month and 63% at 12 months. Pooled odds ratio for death of infected versus noninfected patients was 3.75 (95% confidence interval, 2.12-4.23). In 101 studies that reported spontaneous bacterial peritonitis (7062 patients), the median mortality was 43.7%: 31.5% at 1 month and 66.2% at 12 months. In 30 studies that reported bacteremia (1437 patients), the median mortality rate was 42.2%. Mortality before 2000 was 47.7% and after 2000 was 32.3% (P = .023); mortality was reduced only at 30 days after spontaneous bacterial peritonitis (49% vs 31.5%; P = .005). CONCLUSIONS: In patients with cirrhosis, infections increase mortality 4-fold; 30% of patients die within 1 month after infection and another 30% die by 1 year. Prospective studies with prolonged follow-up evaluation and to evaluate preventative strategies are needed.