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Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study.

(2014) LIVER INTERNATIONAL. 34(10). p.1496-1503
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Abstract
Background: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. Aims: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. Methods: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. Results: The EPIC II database includes 13796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P<0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P<0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P<0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P<0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P<0.05). Conclusions: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.
Keywords
cirrhosis, infection, mortality, organ failure, INTENSIVE-CARE UNITS, TUMOR-NECROSIS-FACTOR, BACTERIAL-INFECTIONS, SEVERE SEPSIS, MORTALITY, INTERLEUKIN-6, DEFINITIONS, SURVIVAL, OUTCOMES, SCORES

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Citation

Please use this url to cite or link to this publication:

Chicago
Gustot, Thierry, Peter Felleiter, Peter Pickkers, Yasser Sakr, Jordi Rello, Dimitrios Velissaris, Charalampos Pierrakos, et al. 2014. “Impact of Infection on the Prognosis of Critically Ill Cirrhotic Patients: Results from a Large Worldwide Study.” Liver International 34 (10): 1496–1503.
APA
Gustot, Thierry, Felleiter, P., Pickkers, P., Sakr, Y., Rello, J., Velissaris, D., Pierrakos, C., et al. (2014). Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study. LIVER INTERNATIONAL, 34(10), 1496–1503.
Vancouver
1.
Gustot T, Felleiter P, Pickkers P, Sakr Y, Rello J, Velissaris D, et al. Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study. LIVER INTERNATIONAL. 2014;34(10):1496–503.
MLA
Gustot, Thierry, Peter Felleiter, Peter Pickkers, et al. “Impact of Infection on the Prognosis of Critically Ill Cirrhotic Patients: Results from a Large Worldwide Study.” LIVER INTERNATIONAL 34.10 (2014): 1496–1503. Print.
@article{8573347,
  abstract     = {Background: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. 
Aims: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. 
Methods: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. 
Results: The EPIC II database includes 13796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51\%, P{\textlangle}0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19\%, P{\textlangle}0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47\%, P{\textlangle}0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42\%, compared to 24\% in the non-cirrhotic population (P{\textlangle}0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41\% and 71\% vs. 30\% and 49\%, respectively, P{\textlangle}0.05). 
Conclusions: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.},
  author       = {Gustot, Thierry and Felleiter, Peter and Pickkers, Peter and Sakr, Yasser and Rello, Jordi and Velissaris, Dimitrios and Pierrakos, Charalampos and Taccone, Fabio S and Sevcik, Pavel and Moreno, Christophe and Vincent, Jean-Louis and EPIC II Group of Investigators, for the  and De Waele, Jan},
  issn         = {1478-3223},
  journal      = {LIVER INTERNATIONAL},
  language     = {eng},
  number       = {10},
  pages        = {1496--1503},
  title        = {Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study.},
  url          = {http://dx.doi.org/10.1111/liv.12520},
  volume       = {34},
  year         = {2014},
}

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