Nosocomial Infections Are Frequent and Negatively Impact Outcomes in Hospitalized Patients With Cirrhosis
Nosocomial Infections Are Frequent and Negatively Impact Outcomes in Hospitalized Patients With Cirrhosis
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DOI：
10.14309/ajg.0000000000000280
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发表时间：
2019-07-01
影响因子：
9.8
通讯作者：
Reddy, K. Rajender
中科院分区：
文献类型：
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作者：
Bajaj, Jasmohan S.;O'Leary, Jacqueline G.;Reddy, K. Rajender
目的：院内感染（NIs）可能是肝硬化发病和死亡的主要原因。本研究旨在确定NI发展的决定因素及其对住院肝硬化患者30天预后的影响。方法：北美终末期肝病研究协会纳入了非选择性住院的肝硬化患者。比较NI患者和非NI患者的入院变量和30天结局。还根据是否存在孤立入院感染、NI或两者同时存在进行比较。使用入院变量和30天死亡率创建NI发展模型。结果：纳入2864例患者；其中15% （n = 436）为NI。当比较NI和非NI时，发现1866名患者无感染，而562名患者只有入院感染，228名患者只有NI， 208名患者两种感染。入院时，NI患者更有可能被感染并有晚期肝硬化。与入院感染无关，NIs与急性慢性肝衰竭、死亡和移植的较高发生率相关。与没有NI的患者相比，NI患者的呼吸道感染、尿路感染、艰难梭菌感染、真菌感染和耐万古霉素肠球菌感染较高。NIs的危险因素包括入院感染、终末期肝病模型（MELD） bbb20、全身炎症反应综合征标准、质子泵抑制剂、利福昔明和乳果糖的使用，但回归模型（敏感性为0.67，特异性为0.63）并不稳健。年龄、酒精病因、入院MELD评分、乳果糖使用、急性慢性肝功能衰竭、急性肾损伤、重症监护病房和NI增加了死亡风险，而利福昔明降低了死亡风险。讨论：NIs在肝硬化住院患者中普遍存在，并与不良预后相关。虽然较高的MELD评分和全身性炎症反应综合征与NI相关，但所有住院肝硬化患者都需要警惕和预防策略。
OBJECTIVES: Nosocomial infections (NIs) can be a major cause of morbidity and mortality in cirrhosis. This study aims to define the determinants of NI development and its impact on 30-day outcomes among hospitalized patients with cirrhosis. METHODS: North American Consortium for the Study of End-Stage Liver Disease enrolled patients with cirrhosis who were admitted nonelectively. Admission variables and 30-day outcomes were compared between patients with and without NI. These were also compared based on whether there was an isolated admission infection, NI, or both. Models were created for NI development using admission variables and for 30-day mortality. RESULTS: The study included 2,864 patients; of which, 15% (n = 436) developed NI. When comparing NI vs no NI, 1,866 patients were found to be infection free, whereas 562 had admission infections only, 228 had only NI, and 208 had both infections. At admission, patients with NI were more likely to be infected and have advanced cirrhosis. NIs were associated with higher rates of acute-on-chronic liver failure, death, and transplant regardless of admission infections. Patients with NI had higher respiratory infection, urinary tract infection, Clostridium difficile infection, fungal infections, and infection with vancomycin-resistant enterococci compared with patients without NI. Risk factors for NIs were admission infections, model for end-stage liver disease (MELD) > 20, systemic inflammatory response syndrome criteria, proton pump inhibitor, rifaximin, and lactulose use, but the regression model (sensitivity, 0.67; specificity, 0.63) was not robust. Age, alcohol etiology, admission MELD score, lactulose use, acute-on-chronic liver failure, acute kidney injury, intensive care unit, and NI increased the risk of death, whereas rifaximin decreased the risk of death. DISCUSSION: NIs are prevalent in hospitalized patients with cirrhosis and are associated with poor outcomes. Although higher MELD scores and systemic inflammatory response syndrome are associated with NI, all hospitalized patients with cirrhosis require vigilance and preventive strategies.