Pierre Nahon1, Mathilde Lescat2, Richard Layese3, Valérie Bourcier1, Nabila Talmat1, Setty Allam4, Patrick Marcellin5, Dominique Guyader6, Stanislas Pol7, Dominique Larrey8, Victor De Lédinghen9, Denis Ouzan10, Fabien Zoulim11, Dominique Roulot12, Albert Tran13, Jean-Pierre Bronowicki14, Jean-Pierre Zarski15, Odile Goria16, Paul Calès17, Jean-Marie Péron18, Laurent Alric19, Marc Bourlière20, Philippe Mathurin21, Jean-Frédéric Blanc22, Armand Abergel23, Lawrence Serfaty24, Ariane Mallat25, Jean-Didier Grangé26, Pierre Attali27, Yannick Bacq28, Claire Wartelle29, Thông Dao30, Yves Benhamou31, Christophe Pilette32, Christine Silvain33, Christos Christidis34, Dominique Capron35, Brigitte Bernard-Chabert36, Sophie Hillaire37, Vincent Di Martino38, Jean-Claude Trinchet1, Richard Moreau5, Françoise Roudot-Thoraval3. 1. AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France. 2. AP-HP, Hôpital Jean Verdier, Service de Microbiologie, Bondy, Université Paris 13, Bobigny, et INSERM UMR 1139, Paris, France. 3. AP-HP, Hôpital Henri Mondor, Département de Santé Publique, Créteil, France. 4. Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France. 5. AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France. 6. CHU Pontchaillou, Service d'Hépatologie, Rennes, France. 7. AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris, France. 8. Hôpital Saint Eloi, Service d'Hépatologie, Montpellier, France. 9. Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux, France. 10. Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France. 11. Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon, France. 12. AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France. 13. CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France. 14. Hôpital Brabois, Service d'Hépatologie, Vandoeuvre-les-Nancy, France. 15. Hôpital Michallon, Service d'Hépatologie, Grenoble, France. 16. Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France. 17. CHU d'Angers, Service d'Hépatologie, Angers, France. 18. Hôpital Purpan, Service d'Hépatologie, Toulouse, France. 19. CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France. 20. Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France. 21. Hôpital Claude Huriez, Service d'Hépatologie, Lille, France. 22. Hôpital St André, Service d'Hépatologie, Bordeaux, France. 23. Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France. 24. AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France. 25. AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France. 26. AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris, France. 27. AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France. 28. Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, Tours, France. 29. Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France. 30. Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France. 31. AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France. 32. CHU Le Mans, Service d'Hépatologie, Le Mans, France. 33. CHU de Poitiers, Service d'Hépatologie, Poitiers, France. 34. Institut Mutualiste Montsouris, Service d'Hépatologie, Paris, France. 35. Hôpital Amiens Nord, Service d'Hépatologie, Amiens, France. 36. Hôpital Robert Debré, Service d'Hépatologie, Reims, France. 37. Hôpital Foch, Service d'Hépatologie, Suresnes, France. 38. Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, France.
Abstract
OBJECTIVE: To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis. DESIGN: This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child-Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework. RESULTS: 1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control. CONCLUSION: BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis. DESIGN: This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child-Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework. RESULTS: 1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control. CONCLUSION: BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Entities:
Keywords:
BACTERIAL INFECTION; CIRRHOSIS; HEPATITIS B; HEPATITIS C
Authors: Rianne A Weersink; Margriet Bouma; David M Burger; Joost P H Drenth; S Froukje Harkes-Idzinga; Nicole G M Hunfeld; Herold J Metselaar; Margje H Monster-Simons; Sandra A W van Putten; Katja Taxis; Sander D Borgsteede Journal: Br J Clin Pharmacol Date: 2018-06-07 Impact factor: 4.335