Risk Factors Of Infection In Patients With Esophageal And Gastric Varices After Endoscopic Treatment

ObjectiveAnalyze and summarize the incidence of postoperative infection after endoscopic treatment of cirrhosis with esophageal and gastric varices,the common infection sites,common infection pathogens,and infection and fever,and discuss the main risk factors for infection,Provide clinical data for prevention and treatment of endoscopic postoperative infections to improve prognosis.MethodAdmission data of patients with cirrhosis in the Tianjin Third Central Hospital,of which 96 cases of hepatitis B cirrhosis,17 cases of hepatitis C cirrhosis,11 cases of autoimmune liver cirrhosis,10 cases of primary biliary cirrhosis,31 cases of alcoholic cirrhosis,40 cases of unexplained cirrhosis,2cases of cirrhosis were collected.We recorded patient's age,sex,etiology of liver cirrhosis,with or without diabetes mellitus,with or without ascites,with or without gastrointestinal bleeding,preoperative liver function grading,degree of varicose veins,endoscopic treatment way,Endoscopic treatment site.According to leukocyte and neutrophil levels,PCT,imaging data,etiological test results,patients with elevated white blood cells and neutrophils,elevated PCT,positive imaging findings,pathogenic microorganisms detected by etiology were included in the infection group(102 cases),and the rest were included in non-emergent group(105 cases).Summarize the incidence of postoperative infections and common sites of infection in patients with cirrhosis and esophageal varices.Univariate analysis and Logistic regression analysis were performed by SPSS19.0 to screen the main risk factors affecting postoperative infection in patients with cirrhosis and esophageal varices.Result1.The incidence of postoperative infection in cirrhotic esophageal and gastric varices was 49.3% in this study.The most common site of infection was respiratory tract infections,totaling 66 cases(64.7%),followed by abdominal infections in 18 cases(17.65).%),urinary tract infection in 14 cases(13.73%).2.Among the 102 infected patients,25 patients were tested for blood andbody etiology.A total of 14 pathogens were isolated.There were 3 cases of Klebsiella pneumoniae,2 cases each of Escherichia coli,Enterococcus faecium,and Neisseria gonorrhoeae,1 case each of Streptococcus pneumoniae,Acinetobacter baumannii,Streptococcus trachea,Streptococcus oralis and Candida albicans.8 cases were Gram-negative bacteria,accounting for 57.14%,5cases were Gram-positive bacteria,accounting for 35.71%,and 1 case was fungi,accounting for 7.14%.3.96 patients(46.4%)had fever after endoscopic treatment,63(65.6%)in the infection group,and 33(34.4%)in the non-infection group.Postoperative infection rate was higher in fever patients.There were differences between the two groups.Statistical significance,P<0.05.4.Univariate analysis showed that there was no significant difference in gender,age,etiology,diabetes status,degree of EV,degree of GV,endoscopic treatment,and endoscopic treatment between the two groups(P>0.05).Liver function,ascites,albumin,total bilirubin,and prothrombin time before surgery were statistically significant(P<0.05).Patients with preoperative bleeding,ascites,and poor preoperative liver function had a high postoperative infection rate.Albumin levels in the infected group(33.04+6.30 g/L)were lower than those in the non-infected group(35.39+4.94 g/L).The total bilirubin levels in the infected group(26.34+15.28 umol/L)were higher than those in the non-infected group(20.85+11.79 umol/L).The prothrombin time in the infected group(17.13+3.20s)was higher than that in the non-infected group(15.75+2.06s).5.Logistic regression analysis showed that bleeding,liver function,TBIL,ALB,and PT were the main risk factors for infection after endoscopic treatment in patients with cirrhosis and esophageal varices.Patients with more bleeding,worse liver function,higher total bilirubin levels,lower albumin levels,and prolonged prothrombin time had higher postoperative infection rates.Conclusion1.The incidence of postoperative infection in cirrhotic esophageal and gastric varices was 49.3%.The most common site of infection was respiratory infection,followed by intra-abdominal infection and urinary tract infection.Othersites were rare.The most common pathogens after infection are gram-negative bacteria,of which Klebsiella pneumoniae and E.coli are relatively high.2.The incidence of fever after endoscopic treatment of cirrhosis of esophagogastric varices was 46.4%.Infection was the most common cause of fever and accounted for 65.6% of the total fever;34.4% of fever was unrelated to infection.3.The combination of recent gastrointestinal bleeding,liver function classification,TBIL,ALB,PT before treatment is the main risk factor for infection after endoscopic treatment of sclerosing esophageal gastric varices.In patients with bleeding volume >500 mL,infection after endoscopic treatment is5.272 times than that of patients without bleeding.In patients with liver function? 10 point,infection after endoscopic treatment is 16.762 times than that of patients with liver function?6 point;in patients with TBIL of 34-51 umol/L,infection after endoscopic treatment is 2.778 times than that of patients with TBIL of <34umol/l,in patients with TBIL> 51umol/L,infection after endoscopic treatment is 10.667 times than that of patients with TBIL of <34umol/L.In patients with ALB <28 g/L,infection after endoscopic treatment is 5.552 times than that of patients with ALB>35 g/L.In patients with PT>17.4s,infection after endoscopic treatment is 3.619 times than patients with PT<15.4s.