Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

作者：Javier Fernández, Juan Acevedo, Reiner Wiest, Thierry Gustot, Àlex Amorós, Carme Deulofeu, Enric Reverter, Javier Martínez, Faouzi Saliba, Rajiv Jalan, Tania M. Welzel, Marco Pavesi, María Hernández‐Tejero, Pere Ginès, Vicente Arroyo · 发表于：Gut · 年份：2017 · DOI：10.1136/gutjnl-2017-314240 · 被引用次数：581 · 研究领域：Liver Disease and Transplantation、Sepsis Diagnosis and Treatment、Drug-Induced Hepatotoxicity and Protection

Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival. PATIENTS: 407 patients with ACLF and 235 patients with acute decompensation (AD). RESULTS: 152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality...