Download PDF
CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2024; 14(02): 041-047
DOI: 10.1055/s-0045-1809033
Original Article

Prevalence and Predictors of Bacterial Infection in Hospitalized Patients with Liver Cirrhosis

Mukesh Kumar Ranjan 
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
,
Pradeep Neupane
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
,
Bigyan Maharjan
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
,
Roshan Kumar Yadav
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
,
Ankit Shrestha
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
,
Hari Shrestha
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
,
Neeraj Pandey
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
,
Aashish Tiwari
1   Department of Gastroenterology and Hepatology, Chitwan Medical College and Teaching Hospital, Bharatpur, Nepal
› Author Affiliations
Funding None.
› Further Information
Also available at
  Permissions and Reprints

Abstract

Background

Infections adversely affect the prognosis of patients with liver cirrhosis. The study aimed to analyze the prevalence and the predictors of infections in patients admitted with cirrhosis.

Methods

After obtaining ethical approval, this retrospective study was conducted at a tertiary care center between April 2021 and January 2024. All the patients admitted with cirrhosis were included. Infections were identified according to the standard definitions.

Results

Of the 417 patients (mean age: 54.28 ± 12.61 years; male: 299 [71.70%]), 375 (89.92%) had alcohol-related cirrhosis. The mean Child–Turcotte–Pugh (CTP), Model for End-Stage Liver Disease (MELD), and Model for End-Stage Liver Disease with sodium (MELD-Na) scores were 9.6 ± 2.2, 18.3 ± 8.3, and 20.1 ± 8.3, respectively. Infections were seen in 62 (14.86%) patients. The most prevalent infections were urinary tract infection (26 [6.23%]), spontaneous bacterial peritonitis (18 [4.31%]), bloodstream infection (7 [1.67%]), pneumonia (5 [1.19%]), cellulitis (4 [0.95%]), tuberculosis (3 [0.71%]), and upper respiratory tract infection (2 [0.47%]). Patients with infection had significantly high MELD (p = 0.01) and MELD-Na (p = 0.00) scores, and low albumin (p = 0.04) and sodium (p < 0.001) levels. On univariate analysis, ascites (odds ratio [OR]: 1.85; 95% confidence interval [CI]: 1.07–3.19; p = 0.02), gastrointestinal bleeding (OR: 0.50; 95% CI: 0.26–0.98; p = 0.04), MELD (OR: 1.04; 95% CI: 1.00–1.07; p = 0.01), MELD-Na (OR: 1.05; 95% CI: 1.01–1.08; p < 0.001), albumin (OR: 0.59; 95% CI: 0.36–0.98; p = 0.04), and sodium (OR: 0.93; 95% CI: 0.89–0.98; p < 0.001) predicted the presence of infection. On multivariate analysis, ascites (OR: 2.95; 95% CI: 1.06–8.17; p = 0.03) and the presence of comorbidity (OR: 2.74; 95% CI: 1.02–7.31; p = 0.04) were the only predictors of infection.

Conclusion

Infections were present in approximately 15% of the patients with cirrhosis. The presence of ascites and comorbidities predicted infection in admitted cirrhotic patients.

Keywords

infections - liver cirrhosis - peritonitis - predictor - prevalence

Ethical Approval

The institute review committee (IRC) approved this study (approval number: CMC-IRC/080/081–089).


Consent to Participate

Since this was a retrospective study, consent was not required.


Authors' Contributions

M.K.R. was involved in conceptualization, data collection, supervision, data analysis, manuscript writing, revision, and editing. P.N., B.M., and R.K.Y. contributed to data collection, literature review, data analysis, manuscript writing, and editing. A.S., H.S., N.P., and A.T. were responsible for data collection, literature review, data analysis, and manuscript writing.


Data Availability Statement

The data can be obtained from the corresponding author, provided there is a genuine request.




Publication History

Received: 28 December 2024

Accepted: 23 February 2025

Article published online:
22 May 2025

© 2025. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Racanelli V, Rehermann B. The liver as an immunological organ. Hepatology 2006; 43 (2, Suppl 1): S54-S62
    Search in Google Scholar
  • 2 Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 2014; 61 (06) 1385-1396
    Search in Google Scholar
  • 3 Bonnel AR, Bunchorntavakul C, Reddy KR. Immune dysfunction and infections in patients with cirrhosis. Clin Gastroenterol Hepatol 2011; 9 (09) 727-738
    Search in Google Scholar
  • 4 Piano S, Singh V, Caraceni P. et al; International Club of Ascites Global Study Group. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. Gastroenterology 2019; 156 (05) 1368-1380.e10
    Search in Google Scholar
  • 5 Piano S, Bunchorntavakul C, Marciano S, Rajender Reddy K. Infections in cirrhosis. Lancet Gastroenterol Hepatol 2024; 9 (08) 745-757
    Search in Google Scholar
  • 6 Rimola A, García-Tsao G, Navasa M. et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000; 32 (01) 142-153
    Search in Google Scholar
  • 7 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36 (05) 309-332
    Search in Google Scholar
  • 8 Surana NK, Dinarello CA, Porat R. Fever. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson JL. eds. Harrison's Principles of Internal Medicine. 21st ed.. New York, NY: McGraw-Hill Education; 2022
    Search in Google Scholar
  • 9 Milovanovic T, Pantic I, Velickovic J. et al. Bacteremia in patients with liver cirrhosis in the era of increasing antimicrobial resistance: single-center epidemiology. J Infect Dev Ctries 2021; 15 (12) 1883-1890
    Search in Google Scholar
  • 10 Maitre S. Cellulitis: definition, etiology, diagnosis and treatment. Virtual Mentor 2006; 8 (12) 831-833
    Search in Google Scholar
  • 11 Jalan R, Fernandez J, Wiest R. et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014; 60 (06) 1310-1324
    Search in Google Scholar
  • 12 Schmidt ML, Barritt AS, Orman ES, Hayashi PH. Decreasing mortality among patients hospitalized with cirrhosis in the United States from 2002 through 2010. Gastroenterology 2015; 148 (05) 967-977.e2
    Search in Google Scholar
  • 13 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 (04) 1246-1256 , 1256.e1–1256.e5
    Search in Google Scholar
  • 14 Borzio M, Salerno F, Piantoni L. et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis 2001; 33 (01) 41-48
    Search in Google Scholar
  • 15 Fernández J, Navasa M, Gómez J. et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35 (01) 140-148
    Search in Google Scholar
  • 16 Baijal R, Amarapurkar D, Praveen Kumar HR. et al. A multicenter prospective study of infections related morbidity and mortality in cirrhosis of liver. Indian J Gastroenterol 2014; 33 (04) 336-342
    Search in Google Scholar
  • 17 Yoshida H, Hamada T, Inuzuka S, Ueno T, Sata M, Tanikawa K. Bacterial infection in cirrhosis, with and without hepatocellular carcinoma. Am J Gastroenterol 1993; 88 (12) 2067-2071
    Search in Google Scholar
  • 18 Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993; 18 (03) 353-358
    Search in Google Scholar
  • 19 Fernández J, Gustot T. Management of bacterial infections in cirrhosis. J Hepatol 2012; 56 (Suppl. 01) S1-S12
    Search in Google Scholar
  • 20 Lameirão Gomes C, Violante Silva R, Carrola P, Presa J. Bacterial infections in patients with liver cirrhosis in an internal medicine department. GE Port J Gastroenterol 2019; 26 (05) 324-332
    Search in Google Scholar
  • 21 Mathurin S, Chapelet A, Spanevello V. et al. Infections in hospitalized patients with cirrhosis. Medicina (B Aires) 2009; 69 (02) 229-238
    Search in Google Scholar
  • 22 Patnaik SK, Mohanty S, Mishra D. et al. A prospective study on the clinical significance of infections in a hospital setting among the cirrhotic patients and their outcomes. Cureus 2023; 15 (04) e37912
    Search in Google Scholar
  • 23 Amoako D, Frempong AA, Sedina AA. et al. Bacterial infections in patients with liver cirrhosis: prevalence, predictors, and in-hospital mortality at a district hospital in Ghana. Rwanda J Med Health Sci 2022; 5 (01) 46-54
    Search in Google Scholar
  • 24 Jepsen P. Comorbidity in cirrhosis. World J Gastroenterol 2014; 20 (23) 7223-7230
    Search in Google Scholar
  • 25 Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev 2020; 16 (05) 442-449
    Search in Google Scholar
  • 26 Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease. Adv Chronic Kidney Dis 2019; 26 (01) 8-15
    Search in Google Scholar