Bacterial Infections Change Natural History of Cirrhosis Irrespective of Liver Disease Severity.

OBJECTIVES: We assessed the prognostic significance of infections in relation to current prognostic scores and explored if infection could be considered per se a distinct clinical stage in the natural history of cirrhosis. METHODS: We included consecutive patients with cirrhosis admitted to a tertiary referral liver unit for at least 48 h over a 2-year period. Diagnosis of infection was based on positive cultures or strict established criteria. We used competing risk analysis and propensity score matching for data analysis. RESULTS: 501 patients (63% male, 48% alcoholic liver disease, median Model of End-stage Liver Disease (MELD)=17) underwent 781 admissions over the study period. Portal hypertensive bleeding and complicated ascites were the commonest reasons of admission. The incidence of proven bacterial infection was 25.6% (60% community acquired and 40% nosocomial). Survival rates at 3, 6, 12, and 30 months were 83%, 77%, 71%, and 62% in patients without diagnosis of infection, vs. 50%, 46%, 41%, and 34% in patients with diagnosis of infection. Overall survival was independently associated with MELD score (hazards ratio (HR) 1.099), intensive care (ITU) stay (HR 1.967) and bacterial infection (HR 2.226). Bacterial infection was an independent predictor of survival even when patients who died within the first 30 days were excluded from the analysis in Cox regression (HR 2.013) and competing risk Cox models in all patients (HR 1.46) and propensity risk score-matched infected and non-infected patients (HR 1.67). CONCLUSIONS: Infection most likely represents a distinct prognostic stage of cirrhosis, which affects survival irrespective of disease severity, even after recovery from the infective episode.

Training-induced changes on blood lactate profile and critical velocity in young swimmers.

This study examines the efficacy of critical swimming velocity (CV) for training prescription and monitoring the changes induced on aerobic endurance after a period of increased training volume in young swimmers. An experimental group (E: n = 7; age: 13.3 ± 1.3 years), which participated in competitive training was tested at the beginning (W0), the sixth week (W6), and 14th week (W14) to compare the changes of aerobic endurance indexes (CV; lactate threshold [LT]; velocity corresponding to blood lactate concentration of 4 mmol · L: V4). A control group (C: n = 7; age: 14.1 ± 1.6 years), which refrained from competitive training, was used to observe maturation effects and was tested for CV changes between W0 and W14. The average weekly training volume was increased after the sixth week in the E group and was unchanged for the C group. The CV was not different between or within groups at W0 and W14 (p > 0.05). The LT of the E group was no different compared to V4 and CV at W0 and W6 (p > 0.05) but was higher than CV at W14 (p < 0.05). The LT increased (6.5 ± 5.3%, p < 0.05), but V4 and CV were unchanged after W6 (3.6 ± 1.9%; 2.1 ± 1.2%, p > 0.05). LT, V4, and CV were unchanged despite the increased training volume from W6 to W14 (LT: 1.2 ± 4.3%, V4: 0.8 ± 1.5%, CV: 0.3 ± 0.8%; p > 0.05). These findings suggest that CV pace may be effectively used for the improvement of aerobic endurance in young swimmers. The aerobic endurance indexes used for the assessment of swimmers' progression showed different rates of change as a response to the same training stimulus and cannot be used interchangeably for training planning.