Clinical course and risk factors for infection in severe forms of alcohol‐associated liver disease
Hepatology Aug 15, 2021
Sanchez LO, Karakike E, Njimi H, et al. - In a comparison of patients with decompensated alcohol-associated cirrhosis (DAC), patients with severe alcohol-associated hepatitis (sAH) are more susceptible to develop an infection. Patients who were infected share a similar mortality rate in life-threatening forms of alcohol-associated liver disease (ALD). The results demonstrated that corticosteroid treatment, not sAH, appears to be the main risk factor triggering invasive fungal infections (IFI).
Researchers recruited a total of 207 patients: 139 with sAH and 68 with DAC. At 90 days, 117 (84%) patients with sAH and 41 (60%) patients with DAC experienced at least one infection episode (P < 0.001).
Factors correlated with the development of infection were the presence of sAH and baseline MELD score in multivariable analysis.
In the two groups, bacterial infections represented the most common infection, and only the MELD score was independently correlated with the occurrence of bacterial infection.
Pneumonia was the most prevalent bacterial infection in both groups, and gram-negative bacilli were the main pathogens.
They observed invasive fungal infections (IFI) in 20 (14.5%) patients with sAH and 3 (4.5%) patients with DAC (P < 0.05).
Furthermore, multivariable regression demonstrated that younger age, higher MELD, and corticosteroid therapy were independently correlated with IFI.
The 90-day cumulative incidence of death was 46% and 41.5% in patients infected with sAH and patients infected with DAC, respectively (P = 0.43).
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