| Background and aim:Bacterial infection(BI)is one of common complications in patients with cirrhosis and is associated with high risk of mortality.Alterations in Clinical,immunological and gut microbiome characteristics after BIs may occur in patients with cirrhosisIn order to early prevent progression of cirrhosis and reduce the risk of death,we have to identify key clinical indexes in patients with cirrhosis and BIs.Methods:1.A prospective,observational cohort study was performed to collect demographic,laboratory and microbiological data of patients with cirrhotic patients admitted to our center.Patients were followed up until death,liver transplantation or discharge.Sepsis was diagnosed by sepsis-3(increase of SOFA>2 points from baseline or SOFA>2 when baseline was not clear),SIRS()or quick SOFA(qSOFA,at least two among alteration in mental status,systolic blood pressure<100 mmHg or respiratory rate>22/min).2.The clinical data of cirrhosis patients admitted to the Infectious Diseases Department were collected.According the presence and severity of bacterial infections,the patients were divided into three groups:patients without BIs,those with BIs,and those with sepsis.Circulating cytokines and leukocyte subsets were detected through flow cytometry,and the levels of complement and immunoglobulin were measured regularly in our hospital.Multivariate COX regression was used to analyze the risk factors of mortality at 28-day and 90-day in the patients with cirrhosis and bacterial infections.3.Fecal specimens from patients with liver cirrhosis during hospitalization were collected.Gut microbiome was compared among healthy controls,cirrhotic patients without BIs,patients with Non-septic BIs,and those with sepsis using second-generation deep sequencing.Results:1.1291 patients with cirrhosis were analyzed and 303(23.5%)patients with bacterial infections through hospitalization.Risk factors for nosocomial bacterial infections included ascites within recent 3 months(Odds ratio,OR=3.26,95%CI:2.13-5.01,p<0.001),hepatic encephalopathy within recent 3 months(OR= 2.33,95%CI:1.30-4.15,p = 0.004),bacterial infections within recent 3 months(OR=54.54,95%Cl;17.12-173.76,p<0.001),drug-resistant infections at admission(OR=54.54,95%CI:17.12-173.76,p<0.001),use of diuretics(OR=2.52,95%CI:1.38-4.61,p = 0.003).The protecting factors wasuse of albumin(OR=0.48,95%CI:0.29-0.80,p = 0.004).And the risk factors for second infection during hospitalization Including ascites in the past 3 months(OR = 3.81,95%Cl:1.99-7.29,p<0.001),bacterial infection in the past 3 months(OR = 22.94,95%Cl:10.88-48.37,p<0.001),drug-resistant infections admission(OR = 17.59,95%CI:6.13-50.47,p<0.001),invasive procedures during hospitalization(OR = 2.06,95%CI:1.01-4.21,p = 0.047)and use of diuretics(OR =7.77 95%CI:1.64-35.90,p = 0.010).The risk factors for 28-day mortality included elder age(HR = 1.02,95%CI:1.01-1.05,p = 0.027),hospital-acquired infections(HR = 2.06,95%CI:1.03-4.12,p =0.040)and higher MELD scores(HR = 1.12,95%CI:1.10-1.15,p<0.001).The risk factors for 90-day mortality included elder age(HR = 1.03,95%CI:1.01-1.05,p<0.001),community acquired infections(HR = 1.69,95%CI:1.11-2.57,p = 0.014),higher MELD score(HR = 1.12,95%CI:1.10-1.14,p... |
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