Clinical Characteristics And Risk Factors Of Patients With Cirrhosis And Severe Liver Injury Complicated By Infection

Objective:To investigate the prevalence of infections in cirrhotic patients with severe liver injury and to explore the risk factors of infections and impact on mortality.Methods:150 cases with severe liver injury were selected from 1,264 patients with cirrhosis who were admitted to Department of Infectious Diseases,First Affiliated Hospital of Zhejiang University from May 2014 to April 2015.Information on incidence,site,and culture of infections were collected and prognosis were followed-up.The risk factors of infections and 90-day mortality were analyzed by multivariate logistic regression analysis and Cox proportional hazards model,respectively.Results:(1)The incidence of infections was 34.67%,among which 36 were community-acquired infections(62.07%)and 22(37.94%)were nosocomial infections.9 had single infection and others developed multiple episodes of infections(17.31%).The most commone site of infections was lung,followed by abdomen(spontaneous bacterial peritonitis),urinary tract,blood source,skin and soft tissue;23 patients(44.23%)with infections were complicated by extrahepatic organ failure;Culture-positive infections were reported in 17 patients(29.31%),Escherichia coli and Klebsiella pneumoniae were most common,among which 57.14%(4/7)of them were ESBL producing strains.(2)There were significant differences in ALT level,WBC,MELD score,28-day mortality and 90-day mortality between patients with or without infections(p<0.05).(3)There were significant differences(p<0.05)between the 90-day death group and the surviving group(p<0.05).(4)The multivariate logistic regression analysis showed that serum sodium level was an independent risk factor of nosocomial infections in cirrhotic patients with severe liver injury(OR=1.112,p=0.047).On multivariate analysis by Cox proportional hazards model,age(HR=1.039,p=0.001),sex(HR=2.010,p=0.043),albumin(HR=1.073,p=0.030),white blood cell(HR=1.081,p=0.010),MELD score(HR=1.308,p<0.001)and nosocomial infection(HR=2.136,p=0.021)was independently associated with 90-day mortality.Conclusions:Secondary infection was common in patients with liver cirrhosis after severe liver injury.The most common site was lung and abdomen and gram-negative bacteia was most common in isolated culture.Serum sodium level was independently associated with nosocomial infections.Infection increased risk of death of cirrhotic patients with severe liver injury.