Z Gastroenterol 2012; 50 - P3_05
DOI: 10.1055/s-0031-1295846

Pyuria in patients with cirrhosis and its impact on survival

T Bruns 1, PA Reuken 1, A Stallmach 1
  • 1Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Gastroenterologie, Hepatologie, Infektiologie, Jena

Aims: In patients with cirrhosis, the occurrence of spontaneous bacterial peritonitis (SBP), bacteremia, or respiratory tract infections increase mortality fourfold. A recent meta-analysis [1] reported that mortality after urinary tract infections in cirrhosis is unknown. Methods: We retrospectively analyzed urinary analysis and clinical data from 325 hospitalized patients with cirrhosis. Risk factors for pyuria (>20 white blood cells [WBC] per µl urine) and proven urinary tract infections (UTI) (pyuria plus urinary culture result ≥105 CFU/ml) were identified using logistic regression. The impact of pyuria on survival was assessed by Kaplan-Meier analysis and Cox proportional hazards.

Results: 194 (60%) subjects had no pyuria, 47 (14%) had UTI, and 84 (26%) had pyuria without existing positive urinary culture result. Female sex (OR 2.5; P=0.001) and higher Child-Pugh score (OR 1.3 per point; P<0.001) were independent predictors of pyuria and of UTI. Median survival did not differ between subjects with pyuria and with UTI (182 days and 175 days), but was markedly lower than in patients without pyuria (694 days; P<0.001).The association of pyuria held true in the subgroups of subjects with Child-Pugh A/B cirrhosis (N=144; P=0.004), Child C cirrhosis (N=181; P=0.031) and in subjects without concomitant infection (N=232; P<0.001). Increasing urine WBC correlated with shorter survival (HR=1.004 per 10 WBC/µl; P<0.001). In multivariate analysis, pyuria (HR=1.63; P=0.003), concomitant infection (HR=1.73; P=0.001), malignancy (HR=2.45; P<0.001), ascites (HR=2.64; P=0.016), vasopressor treatment (HR=2.11; P=0.030), age (HR=1.02 per year; P=0.001), MELD (HR=1.04 per point; P=0.003) and Child-Pugh score (HR=1.17 per point; P=0.005) were independently associated with mortality.

Conclusion: Cirrhotic patients with pyuria have a poor prognosis irrespective of positive urinary culture results. The impact of pyuria on survival is comparable to other bacterial infections.

Literatur: 1. Arvaniti V, D’Amico G, Fede G, et al. Infections in Patients With Cirrhosis Increase Mortality Four-Fold and Should Be Used in Determining Prognosis. Gastroenterology. 2010;139:1246-1256.

Cirrhosis - Mortality - Urinary Tract Infection - Pyuria - Infection