Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort).
Gut
; 66(2): 330-341, 2017 02.
Article
en En
| MEDLINE
| ID: mdl-26511797
ABSTRACT
OBJECTIVE:
To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis.DESIGN:
This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child-Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework.RESULTS:
1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43â months, 234 BIs occurred in 171 patients (5â year CumI 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5â year CumI 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5â year survival 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5â year survival 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control.CONCLUSION:
BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Infecciones Bacterianas
/
Coinfección
/
Cirrosis Hepática
/
Neoplasias Hepáticas
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Gut
Año:
2017
Tipo del documento:
Article
País de afiliación:
Francia