Epidemiology

Infection nearly quadruples mortality in cirrhosis patients

Last Updated: 2010-07-02 18:30:46 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - When cirrhotic patients develop infections, their death rate rises dramatically, European researchers have found.

They have "a worse prognosis even if the infection resolves," senior author Dr. Andrew K. Burroughs from the Royal Free Hospital in London told Reuters Health by e-mail.

In a meta-analysis of studies involving nearly 12,000 patients with cirrhosis, he and his colleagues found that infections prompt an almost fourfold increase in mortality.

The analysis, reported online June 16th in Gastroenterology, included 178 studies with 225 cohorts. The median age was 56, 47% had alcoholic cirrhosis and 39% had hepatitis B or C.

Eighteen studies had relevant data to compare survival in infected versus non-infected patients; 40.4% of the 1135 patients with infection died during follow-up, compared to 19.5% of the 2317 without infection (p = 0.00001, pooled odds ratio 3.75).

As reported in 101 studies, 7062 patients had spontaneous bacterial peritonitis. Their one- and 12-month median mortality rates were 32.5% and 66.2%, respectively.

Among 1437 patients (from 30 studies) with bacteremia, mortality rates were 42.2% and 67.4% at one and 12 months, respectively.

Out of 225 cohorts, only 35 (15.4%) reported prophylactic use of antibiotics, and then only in a median of 7.7% of patients.

Although there were not enough data for a proper evaluation, prophylaxis was associated with reduced mortality from spontaneous bacterial peritonitis (37% versus 43.2%).

In studies conducted after 2000, "there was no significant improvement for mortality at one year, for those surviving the first month...compared to the previous 20 years," the researchers say.

"For infection, in contrast to variceal bleeding, there has not been an improvement in survival over several decades," they write.

Cirrhosis is usually described as compensated in its early stages and decompensated as liver failure develops. Perhaps, the authors suggest, the "critically ill cirrhotic" should be a new prognostic stage.

http://www.gastrojournal.org/article/S0016-5085(10)00878-4/abstract

Gastroenterology 2010.