Epidemiology of acute-on-chronic liver failure (ACLF) associated with bacterial infection in patients with liver cirrhosis: risk factors and outcome

The aims of this study were to describe the epidemiology of infection complicated with acute-on-chronic liver failure (ACLF), to determine its risk factors and to assess the 30-day, 90-day and one year survival in infected cirrhotic patients with or without ACLF. We conducted a prospective study from January 2014 to March 2016. All consecutive patients admitted in three different centres in Northern Italy were included.
A total of 517 patients were admitted for an episode of acute decompensation of which 178 (37%) developed at least one episode of bacterial infection. In 79 (43%) cases infection was complicated with ACLF. At multivariate analysis factors independently associated with ACLF were bacteriemic infection [OR 4.71 (95% CI 2.13 – 10.38), p<0.001], alcohol-related cirrhosis [OR 3.06 (95% CI 1.43-6.35), p=0.004], and infection caused by a MDR pathogen [OR 3.67 (95% CI 1.51- 8.68), p=0.003]. UTIs were associated with lower odds for ACLF [OR 0.23 (95% CI 0.07-0.72), p=0.01]. In a Cox regression model, after adjustment for Charlson score and sex, ACLF-complicated bacterial infection was independently associated to 1-year mortality [AHR 2.54 (95% CI 1.72-3.76), P< 0.001] as well as ACLF unrelated to bacterial infection [AHR 1.92 (95% CI 1.24-2.97), P= 0.003]. Conversely, bacterial infection non-complicated with ACLF was not associated to an increase of long-term mortality [AHR 0.97 (95% CI 0.64-1.47) P= 0.90.]

Matteo Rinaldi
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