Infections worsen survival in
cirrhosis; however, simple predictors of survival in
infection-related
acute-on-chronic liver failure (I-ACLF) derived from multicenter studies are required in order to improve prognostication and resource allocation. Using the North American Consortium for Study of
End-stage Liver Disease (NACSELD) database, data from 18 centers were collected for survival analysis of prospectively enrolled
cirrhosis patients hospitalized with an
infection. We defined organ failures as 1)
shock, 2) grade III/IV
hepatic encephalopathy (HE), 3) need for dialysis and
mechanical ventilation. Determinants of survival with these organ failures were analyzed. In all, 507 patients were included (55 years, 52% hepatitis C virus [HCV], 15.8%
nosocomial infection, 96% Child score ≥ 7) and 30-day evaluations were available in 453 patients.
Urinary tract infection (UTI) (28.5%), and spontaneous bacterial
peritonitis (SBP) (22.5%) were the most prevalent
infections. During hospitalization, 55.7% developed HE, 17.6%
shock, 15.1% required renal replacement, and 15.8% needed ventilation; 23% died within 30 days and 21.6% developed second
infections. Admitted patients developed none (38.4%), one (37.3%), two (10.4%), three (10%), or four (4%) organ failures. The 30-day survival worsened with a higher number of extrahepatic organ failures, none (92%), one (72.6%), two (51.3%), three (36%), and all four (23%). I-ACLF was defined as ≥ 2 organ failures given the significant change in survival probability associated at this cutoff. Baseline independent predictors for development of ACLF were
nosocomial infections, Model for Endstage
Liver Disease (MELD) score, low mean arterial pressure (MAP), and non-SBP
infections. Independent predictors of poor 30-day survival were I-ACLF, second
infections, and admission values of high MELD, low MAP, high white blood count, and low
albumin.
CONCLUSION: