Sebastián Marciano1,2, Melisa Dirchwolf3, Carla S Bermudez4, Natalia Sobenko4, Leila Haddad4, Federico Genre Bert4, Laura Barcán5, Astrid Smud5, Maria Lourdes Posadas-Martínez6, Diego Giunta6, Adrián Gadano4,6. 1. Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina. sebastian.marciano@hospitalitaliano.org.ar. 2. Department of Research, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina. sebastian.marciano@hospitalitaliano.org.ar. 3. Liver Unit, Hospital Privado de Rosario, Presidente Roca 2440, 2000, Rosario, Santa Fe, Argentina. 4. Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina. 5. Infectious Diseases Section, Internal Medicine Department, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina. 6. Department of Research, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina.
Abstract
BACKGROUND AND AIMS: Spontaneous bacteremia is a poorly characterized infection in patients with cirrhosis. We compared the incidence of mortality and acute kidney injury in patients with spontaneous bacterial peritonitis and spontaneous bacteremia, and identified risk factors for mortality and acute kidney injury in patients with spontaneous bacteremia. METHODS: We performed a retrospective cohort study of patients with cirrhosis and spontaneous bacteremia or spontaneous bacterial peritonitis from 2008 to 2016 at Hospital Italiano, Buenos Aires. We compared the cumulative incidence of acute kidney injury and death between the two infections, and identified risk factors for these outcomes in patients with spontaneous bacteremia. RESULTS: Seventy-one patients with spontaneous bacteremia and 55 patients with spontaneous bacterial peritonitis were included. Most infections were nosocomial. Overall, 26% of bacteria were resistant and 11% multi-resistant. We found no significant association between acute kidney injury [subhazard ratio (sHR) 1.05 (95% confidence interval, CI 0.67-1.63, p = 0.83)] or death [sHR 1.15 (95% CI 0.60-2.20, p = 0.68)] and type of spontaneous infection in multivariate analyses adjusting for basal Model for End-Stage Liver Disease (MELD) score. In patients with spontaneous bacteremia, baseline MELD score was independently associated with acute kidney injury [sHR 1.07 (95% CI 1.03-1.11, p = 0.001)] and death [sHR 1.07 (95% CI 1.02-1.15, p = 0.03)]. CONCLUSIONS: Short-term acute kidney injury and mortality rates were similar in patients with spontaneous bacteremia and spontaneous bacterial peritonitis. Risk assessment of patients with spontaneous bacteremia can be performed with baseline MELD score.
BACKGROUND AND AIMS: Spontaneous bacteremia is a poorly characterized infection in patients with cirrhosis. We compared the incidence of mortality and acute kidney injury in patients with spontaneous bacterial peritonitis and spontaneous bacteremia, and identified risk factors for mortality and acute kidney injury in patients with spontaneous bacteremia. METHODS: We performed a retrospective cohort study of patients with cirrhosis and spontaneous bacteremia or spontaneous bacterial peritonitis from 2008 to 2016 at Hospital Italiano, Buenos Aires. We compared the cumulative incidence of acute kidney injury and death between the two infections, and identified risk factors for these outcomes in patients with spontaneous bacteremia. RESULTS: Seventy-one patients with spontaneous bacteremia and 55 patients with spontaneous bacterial peritonitis were included. Most infections were nosocomial. Overall, 26% of bacteria were resistant and 11% multi-resistant. We found no significant association between acute kidney injury [subhazard ratio (sHR) 1.05 (95% confidence interval, CI 0.67-1.63, p = 0.83)] or death [sHR 1.15 (95% CI 0.60-2.20, p = 0.68)] and type of spontaneous infection in multivariate analyses adjusting for basal Model for End-Stage Liver Disease (MELD) score. In patients with spontaneous bacteremia, baseline MELD score was independently associated with acute kidney injury [sHR 1.07 (95% CI 1.03-1.11, p = 0.001)] and death [sHR 1.07 (95% CI 1.02-1.15, p = 0.03)]. CONCLUSIONS: Short-term acute kidney injury and mortality rates were similar in patients with spontaneous bacteremia and spontaneous bacterial peritonitis. Risk assessment of patients with spontaneous bacteremia can be performed with baseline MELD score.
Authors: Sebastián Marciano; Leila Haddad; Alfredo Pedro Martínez; María L Posadas; Federico Piñero; Gonzalo J Mora; Laura N Guerrero; Ezequiel Ridruejo; Oscar G Mandó; Diego H Giunta; Adrián C Gadano Journal: Ann Hepatol Date: 2014 Sep-Oct Impact factor: 2.400
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Authors: P S Kamath; R H Wiesner; M Malinchoc; W Kremers; T M Therneau; C L Kosberg; G D'Amico; E R Dickson; W R Kim Journal: Hepatology Date: 2001-02 Impact factor: 17.425
Authors: Richard Moreau; Rajiv Jalan; Pere Gines; Marco Pavesi; Paolo Angeli; Juan Cordoba; Francois Durand; Thierry Gustot; Faouzi Saliba; Marco Domenicali; Alexander Gerbes; Julia Wendon; Carlo Alessandria; Wim Laleman; Stefan Zeuzem; Jonel Trebicka; Mauro Bernardi; Vicente Arroyo Journal: Gastroenterology Date: 2013-03-06 Impact factor: 22.682