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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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