Impact of infection in hospitalized cirrhotic patients in a university hospital

Background: Infection increases the morbidity and mortality in liver cirrhosis patients. The aim of this study was to investigate the impact of infection related to survival and risk factors for death in adult patients with liver cirrhosis in a university hospital. Methods: In a retrospective cohort study of Brazilian hospitalized cirrhotic patients, medical records data were analysed, and all patients who have had one or more confirmed bacterial infection during admission were selected for the study. Also, some data as biochemical investigation, Child score, MELD estimation, and evolution and death event were included. Statistical analysis: chi-square, Fisher and Mann-Whitney tests were used. Uni and multivariate analysis were performed, according to Cox regression model. The significant statistical level was p < 0.05. Results: In a total of 1221 medical records of hospitalized cirrhotic patients, 107 of them presented the diagnoses of infection. Evolution for death occurred in 29% of patients. The most common infections were spontaneous bacterial peritonitis (32.7%), urinary tract infection (31.8%) and pneumonia (15.9%). Spontaneous bacterial peritonitis (p < 0.027), ascites (p < 0.024), upper gastrointestinal bleeding (p < 0.039) were related with death outcome as well as MELD (p < 0.004), increased serum creatinine (p < 0.021), and low serum sodium (p < 0.010). Patients who had serum sodium < 130 mEq/L, upper gastrointestinal bleeding episodes and serum creatinine > 2.5 mg/dl had increased the risk of death of 4.1, 3.2 and 3.2, respectively. Conclusion: Bacterial infections in hospitalized cirrhotic patients deserve special care, mainly spontaneous bacterial peritonitis, and also patients whose hiponatremia, upper gastrointestinal bleeding, high levels of creatinine and MELD high score are found.