Background and aim: Cirrhosis is associated with the deterioration of the immune system and the altered systemic inflammatory response, which predisposes to bacterial infections and a four-fold increase in mortality. Regarding ACLF, a study published by EF-Clif reported a 33% infection at diagnosis. Another study by Shalimar et al. He reported 10.8% of infections at diagnosis, with a 30-day survival of 24.0%; Infections were associated with ACLF-3 50%. Therefore, we consider it relevant to recognize this condition, since it confers a worse prognosis. Aim: To determine the incidence and impact of bacterial infection on the prognosis of patients with ACLF.
Material and methods: Retrospective descriptive observational study of patients diagnosed with ACLF according to the criteria of the European and American associations, bacterial infections were identified on admission, the records were reviewed, survival curves were evaluated using the Kaplan-Meier method, and the Cox regression with the SPSS statistical program.
Results: In our study, we identified 58 patients who met the ACLF criteria during 2019, of these 53.44% (n31) presented infection on admission. Most frequently, 41.9% (n13) presented urinary tract infection (UTI) followed by 22.5% (n7) spontaneous bacterial peritonitis (SBP), and more than one focused UTI/ SBP 25.8% (n8). Survival at 30 days was compared between patients without infection and with infection, using the Kaplan-Meier method reported a survival of 20% and 19% respectively (p=0.71). A Cox regression was performed to assess whether the type of infection affects mortality, reporting HR=1.14 (p=0.22). In relation to the ACLF degree in patients with G1 infection 29.04% (n9) G2 45.16% (n14) G3 25.8% (n8) without significant difference in relation to mortality HR 1.06 (p=0.83) With a 30-day survival 12.5% Y 30.7 for G1 and G2 (p=0.38 95% CI).
Conclusions: In our population, unlike previous studies, infections were higher, occurring in more than half, with a more frequent UTI followed by SBP, although this does not have an impact on prognosis, giving a survival similar to those patients without infection. Nor was a worse prognosis identified in relation to the types of infection. Grade 2 ACLF was the most frequent but with no significant impact on mortality.
Conflicts of interest: The authors have no conflicts of interest to declare.
