The effect of infections on the mortality of cirrhotic patients with hepatic encephalopathy

• Published in: Epidemiology and infection Vol. 141; no. 12; pp. 2671 - 2678
• Main Authors: HUNG, T. H., LAY, C. J., CHANG, C. M., TSAI, J .J., TSAI, C. C.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-12-2013
• Subjects: Abscesses; Adult; Aged; Aged, 80 and over; Alcoholism; Ascites; Bacterial infections; Biological and medical sciences; Chronic illnesses; Codes; Communicable Diseases - complications; Communicable Diseases - mortality; Comorbidity; Confounding (Statistics); Female; Fundamental and applied biological sciences. Psychology; Hepatic Encephalopathy - complications; Hepatic Encephalopathy - mortality; Hospitalization; Humans; Infection in Chronic Disease; Infectious diseases; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Male; Medical records; Microbiology; Middle Aged; Mortality; National health insurance; Original Papers; Peritonitis; Population; Retrospective Studies; Sepsis; Survival Analysis; Taiwan - epidemiology; Urinary tract diseases; Urinary tract infections; Urogenital system; Taiwan; United States > US; ISEW, Taiwan; Cirrhosis; spontaneous bacterial peritonitis; pneumonia; urinary tract infection; hepatic encephalopathy; Human; Nervous system diseases; Encephalopathy; Central nervous system disease; Digestive diseases; Hepatic disease; Epidemiology; Cerebral disorder
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268813000186

Cirrhotic patients are prone to having infections, which may aggravate hepatic encephalopathy (HE). However, the effect of infections on mortality in HE cirrhotic patients is not well described. The National Health Insurance Database, derived from the Taiwan National Health Insurance Programme, was used to identify 4150 adult HE cirrhotic patients hospitalized between 1 January 2004 and 31 December 2004. Nine hundred and eighty-five patients (23·7%) had one or more co-existing infections during their hospitalization. After Cox proportional hazard regression modelling adjusted by the patients' gender, age, and medical comorbidity disorders, the hazard ratios (HRs) in HE patients with infections for 30-day, 30- to 90-day, and 90-day to 1-year mortalities were 1·66 [95% confidence interval (CI) 1·42–1·94], 1·51 (95% CI 1·23–1·85) and 1·34 (95% CI 1·13–1·58), respectively. Compared to the non-infection group, the HRs of pneumonia, spontaneous bacterial peritonitis, urinary tract infection, sepsis without specific focus (SWSF), cellulitis, and biliary tract infection were 2·11, 1·48, 1·06, 2·21, 1·06, and 0·78, respectively, for 30-day mortality; 1·82, 1·22, 0·93, 2·24, 0·31, and 2·82, respectively, for 30- to 90-day mortality; and 2·03, 0·82, 1·24, 1·64, 1·14, and 0·60, respectively, for 90-day to 1-year mortality for HE cirrhotic patients. We conclude that infections increase the mortality of HE cirrhotic patients, especially pneumonia and SWSF.