Konstantina Sargenti

Healthcare-associated and nosocomial bacterial infections in cirrhosis: predictors and impact on outcome.

Population‐based data on the occurrence of healthcare‐associated (HCA) and hospital‐acquired (HA) bacterial infections in cirrhosis, their predictors, and their impact on outcome are limited.

Predictors of mortality among patients with compensated and decompensated liver cirrhosis: the role of bacterial infections and infection-related acute-on-chronic liver failure.

Abstract Objective. Population-based data on the impact of bacterial infections on the course of compensated and decompensated cirrhosis as well as the occurrence, predictors of infection-related acute-on-chronic liver failure (ACLF) and its fatal outcome are limited. Material and methods. All patients with incident cirrhosis in the period 2001–2010, residing in an area of 600,000 inhabitants, were retrospectively identified. All serious bacterial infections (resulting in or occurring during an inpatient hospital episode) during this period were analyzed. Infection site and acquisition type, comorbid illness (Charlson comorbidity index) and infection severity features were analyzed. Patients were followed up until death, transplant, or the end of 2011. Results. Overall, 398 serious bacterial infections occurred in 241/633 (38%) patients (106/332 diagnosed with compensated and 135/301 with decompensated disease; follow-up time was 2276 patient-years). ACLF occurred in 95/398 (24%) serious infections with an in-hospital mortality of 50%. In logistic regression analysis, the model for end-stage liver disease score, active alcohol misuse and healthcare-associated infections were predictors of infection-related ACLF (p < 0.05 for all). In-hospital mortality in infections with ACLF was related to albumin levels, Charlson comorbidity index >1 and occurrence of one or more organ failures (p > 0.05 for all). In Cox regression analysis, infection-related ACLF was an independent negative predictor of transplant-free survival in decompensated patients (p = 0.049). Conclusions. In a population-based cirrhotic cohort, infection-related ACLF was a negative predictor of survival in decompensated disease. Infection-related ACLF was frequent and related to cirrhosis severity and infection acquisition type, as well as to high inpatient mortality, in particular in patients with significant comorbidity.

Incidence, clinical presentation and mortality of liver cirrhosis in Southern Sweden : A 10-year population-based study

In Sweden, the most common causes of liver cirrhosis are alcohol overconsumption and hepatitis C. However, recent data on the clinical characteristics of Swedish patients with cirrhosis are scarce.

Bacterial infections in alcoholic and nonalcoholic liver cirrhosis

Objectives Longitudinal, population-based data on the occurrence, localization, and severity of bacterial infections over time in patients with alcoholic compared with nonalcoholic cirrhosis are limited. Materials and methods All patients with incident cirrhosis diagnosed in 2001–2010 (area of 600 000 inhabitants) were retrospectively identified. All bacterial infections resulting in or occurring during an inpatient hospital episode during this period were registered. The etiology of cirrhosis (alcoholic vs. nonalcoholic), infection localization, and outcome as well as bacterial resistance patterns were analyzed. Patients were followed until death, transplant, or the end of 2011. Results In all, 633 cirrhotics (363 alcoholic, 270 nonalcoholic) experienced a total of 398 infections (2276 patient-years). Among patients diagnosed with cirrhosis each year from 2001 to 2010, increasing trends were noted in the occurrence of infection (from 13 to 27%, P<0.001) and infection-related in-hospital mortality (from 2 to 7%, P=0.05), the latter mainly in the alcoholic group. Although alcoholic etiology was related to the occurrence of more frequent infection (Kaplan–Meier, P<0.001), this relationship was not significant after adjustment for confounders in Cox regression analysis (P=0.056). Resistance to piperacilin-tazobactam and carbapenems was more common in infections occurring in alcoholic versus nonalcoholic cirrhosis (13 vs. 5%, P=0.057 and 12 vs. 2%, P=0.009). Alcoholic etiology predicted pneumonia and infections caused by Gram-positive bacteria in multivariate analysis (P<0.05 for both). Conclusion In a population-based cirrhotic cohort, bacterial infections increased over time, which, in the case of alcoholic cirrhosis, was associated with pneumonia and bacterial resistance to antibiotics. However, alcoholic etiology was not related indepedently to the occurrence of bacterial infections.

Patients with liver cirrhosis show worse survival if decompensation occurs later during course of disease than at diagnosis

Abstract Objectives: Liver cirrhosis is characterized by a silent phase until decompensation, which is defined by onset of ascites, variceal bleeding, or encephalopathy. Although it is presumed that the survival of decompensated patients is the same regardless of when decompensation occurs, data to support this are scarce. We aimed to study the impact of time of decompensation on the clinical course and survival of patients with cirrhosis in a large population-based cohort. Materials and methods: We used medical registries to define a 10-year cohort of 1317 patients with incident liver cirrhosis in the Scania region of Sweden. Medical records were reviewed. Patients were followed until December 2011, and for death or transplantation until December 2014. Results: In the cohort, 629 patients were decompensated at diagnosis, of which 505 had ascites and 44 variceal bleeding only. During follow-up, 228 patients developed ascites and 39 variceal bleeding as first complication. Patients with ascites as first complication showed worse survival than patients who had ascites at diagnosis. (5-year survival 33% vs. 15%, HR 1.60 (95% CI 1.34–1.90)). This difference persisted after adjustment for confounders, including hepatocellular cancer (HR 1.38 (95% CI 1.15–1.67)). Worse survival was also seen when bleeding from varices occurred during follow-up rather than at diagnosis. Conclusions: Our results provide evidence for an association between transplantation-free survival after decompensation and the time of decompensation in liver cirrhosis, with worse survival when decompensation occurs during follow-up, thus challenging the generally held, view that the survival after decompensation is independent of when decompensation occurs.

Mo1247 Neutrophil and Monocyte Activity in Stable Cirrhosis: Relation With Cirrhosis Etiology and Severity As Well As Cytokine Profile and 25(OH) Vitamin D Levels

Background: Chronic liver disease and cirrhosis are a major cause of morbidity and mortality worldwide. Hospitalizations due to complications of cirrhosis are associated with substantial economic burden. We hypothesized that the hospitalizations related to complications of cirrhosis varies by season based on individuals various indoor/outdoor activities, diet and seasonal infection; and we aim to study seasonal variations in hospitalizations due to complications of cirrhosis in the USA from a large national inpatient database. Methods: The National Inpatient Sample database of year 2011 which was collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized for this study. The NIS is the largest all payer inpatient care database containing around 8 million hospitalizations from around 1000 hospitals in the United States. The hospitalizations related to cirrhosis and its complications including hepatic encephalopathy, esophageal variceal bleeding, and ascites requiring paracentesis were captured using various ICD-9 diagnosis codes. Four seasons were categorized based on the months of hospitalization (spring: March, April, May; summer: June, July, August; fall: September, October, November and winter: December, January, February). Analyses were performed separately different regions of United States. SAS 9.3 was used for analyses. Results: Our study included 36,684 hospitalizations due to complications of cirrhosis which include hepatic encephalopathy, gastrointestinal bleeding, and ascites requiring paracentesis. The hospitalizations related to these complications were comparable across all regions with 24.64% in Spring, 24.70% in Summer, 25.62% in Fall, and 25.00% in Winter. Though wide variation was seen while analyzing data by different regions with highest rate of hospitalizations due to variceal bleeding in the Northeast during spring (34.8%), in the Midwest during fall (31.43%), in the South during winter (27.96%), and in the West highest during summer (27.08%) months. Similarly, hospitalizations due to hepatic encephalopathy in the Northeast were highest in spring (26.22%), in the Midwest during fall (26.25%), in the South during winter (26.13%), and in theWest during summer (25.52%). Hospitalizations due to ascites requiring paracentesis were highest during fall for Northeast (26.98%) and South (27.17%) regions while Midwest and West regions had higher rates during spring (25.60%), and summer (25.87%) respectively.Conclusion: Seasonal variations in hospitalizations due to the complications of cirrhosis are present when hospitalizations due to hepatic encephalopathy, variceal bleeding, and ascites requiring paracentesis are analyzed by various regions. Understanding the factors behind such variations may help guide preventing hospitalizations secondary to these complications.

Su1301 Impact of Infection Type, Acute Kidney Injury, and Systemic Inflammatory Response Syndrome on Survival of Cirrhotic Patients With Bacterial Infections: A Population-Based Cohort Study

G A A b st ra ct s patients has not been examined. The objective of this analysis was to assess the efficacy and tolerability of rifaximin in maintaining remission from HE in cirrhotic patients with HCV. Methods: Breakthrough HE events and tolerability were assessed from a 6-month, randomized, double-blind, placebo-controlled trial of RFX 550 mg BID in cirrhotic patients (n= 299) with a recent history of recurrent HE but in remission at enrollment (Conn Score [CS], 0 or 1). Breakthrough overt HE was defined as an increase in CS to ≥2, or an increase in both CS and asterixis score of 1 grade each for patients entering with a CS of 0. Lactulose was permitted throughout the study. The incidence of adverse events (AEs) was reported. Results: HCV was the etiology of advanced liver disease in 42.8% (128 of 299) of patients. Demographic and baseline characteristics were generally similar between HCV and nonHCV patients. In HCV patients, breakthrough HE events occurred in 26.2% (16 of 61) of RFX patients vs. 47.8% (32 of 67) of PBO patients, corresponding to relative reduction in risk of a breakthrough HE episode of 52.2% (Figure, P=0.014). In cirrhotic patients with other etiologies (eg, alcohol-related, NAFLD/NASH), there were also significant treatmentrelated differences, with 19.0% (15 of 79) of RFX patients experiencing a breakthrough HE event vs. 44.6% (41 of 92) of PBO patients (P,0.001). In HCV patients, the most commonly reported AEs were nausea (RFX:18.0% of patients, PBO:19.4% of patients), fatigue (RFX:14.8%, PBO:13.4%), and peripheral edema (RFX:14.8%, PBO:7.5%). Conclusions: In patients with HCV and recurrent HE, RFX was efficacious and well-tolerated, with a clinical profile similar to that observed for cirrhotic patients with other etiologies of advanced liver disease.