Alcohol Consumption Influences Clinical Outcome in Patients Admitted to a Referral Center for Liver Disease

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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2018;17:476-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 393 "formatos" => array:3 [ "EPUB" => 23 "HTML" => 287 "PDF" => 83 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Thrombosis of the Portal Venous System in Cirrhotic vs. Non-Cirrhotic Patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "476" "paginaFinal" => "481" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 534 "Ancho" => 692 "Tamanyo" => 47964 ] ] "descripcion" => array:1 [ "en" => "Yerdel Classification of Portal Vein Thrombosis. According to our results, fifty-cases had a thrombus in the portal vein or thrombosis in portal vein with invasion of mesenteric vein. The classification of Yerdel divides the portal vein thrombosis into 4 grades.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Grade I: The thrombosis of portal vein affects < 50% of the vessel lumen. Grade II: Thrombosis affects more than 50% of the vessel lumen. Grades I and II could have minimal or no invasion of the superior mesenteric vein. Grade III: There is a complete obstruction of the portal vein and proximal invasion of superior mesenteric vein. Grade IV: The obstruction progressed to distal superior mesenteric vein." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vania Cruz-Ramón, Paulina Chinchilla-López, Oscar Ramírez-Pérez, Nancy E. Aguilar-Olivos, Luis F. Alva-López, Ericka Fajardo-Ordoñez, Guadalupe Ponciano-Rodríguez, Patrick G. Northup, Nicolas Intagliata, Stephen H. Caldwell, Xingshun Qi, Nahum Méndez-Sánchez" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Vania" "apellidos" => "Cruz-Ramón" ] 1 => array:2 [ "nombre" => "Paulina" "apellidos" => "Chinchilla-López" ] 2 => array:2 [ "nombre" => "Oscar" "apellidos" => "Ramírez-Pérez" ] 3 => array:2 [ "nombre" => "Nancy E." "apellidos" => "Aguilar-Olivos" ] 4 => array:2 [ "nombre" => "Luis F." "apellidos" => "Alva-López" ] 5 => array:2 [ "nombre" => "Ericka" "apellidos" => "Fajardo-Ordoñez" ] 6 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "Ponciano-Rodríguez" ] 7 => array:2 [ "nombre" => "Patrick G." "apellidos" => "Northup" ] 8 => array:2 [ "nombre" => "Nicolas" "apellidos" => "Intagliata" ] 9 => array:2 [ "nombre" => "Stephen H." "apellidos" => "Caldwell" ] 10 => array:2 [ "nombre" => "Xingshun" "apellidos" => "Qi" ] 11 => array:2 [ "nombre" => "Nahum" "apellidos" => "Méndez-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119302030?idApp=UINPBA00004N" "url" => "/16652681/0000001700000003/v1_201905160920/S1665268119302030/v1_201905160920/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119302017" "issn" => "16652681" "doi" => "10.5604/01.3001.0011.7390" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "70058" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2018;17:461-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 172 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 114 "PDF" => 50 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Prognostic Significance of The New Criteria for Acute Kidney Injury in Cirrhosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "461" "paginaFinal" => "469" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 551 "Ancho" => 512 "Tamanyo" => 45775 ] ] "descripcion" => array:1 [ "en" => "Ninety-day cumulative survival rate of cirrhotic patients according to the stages of acute kidney injury (AKI). Surviva was significantly lower in the patients with AKI stages 2 and 3 than in those without AKI (P < 0.001, log-rank test). When individuals were compared according to the AKI stage, those with AKI stage 1 had higher survival than those with stage 2 (P = 0.022). No differences were observed between those in stages 2 and 3." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Emilia T.O. Bansho, Pedro Eduardo S. Silva, Bruno S. Colombo, Leticia M. Wildner, Maria Luiza Bazzo, Esther B. Dantas-Corrêa, Leonardo L. Schiavon, Janaína L. Narciso-Schiavon" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Emilia T.O." "apellidos" => "Bansho" ] 1 => array:2 [ "nombre" => "Pedro Eduardo S." "apellidos" => "Silva" ] 2 => array:2 [ "nombre" => "Bruno S." "apellidos" => "Colombo" ] 3 => array:2 [ "nombre" => "Leticia M." "apellidos" => "Wildner" ] 4 => array:2 [ "nombre" => "Maria Luiza" "apellidos" => "Bazzo" ] 5 => array:2 [ "nombre" => "Esther B." "apellidos" => "Dantas-Corrêa" ] 6 => array:2 [ "nombre" => "Leonardo L." "apellidos" => "Schiavon" ] 7 => array:2 [ "nombre" => "Janaína L." "apellidos" => "Narciso-Schiavon" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119302017?idApp=UINPBA00004N" "url" => "/16652681/0000001700000003/v1_201905160920/S1665268119302017/v1_201905160920/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "titulo" => "Alcohol Consumption Influences Clinical Outcome in Patients Admitted to a Referral Center for Liver Disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "470" "paginaFinal" => "475" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Suyan G.R. dos Santos, Angelo A. Mattos, Marcela M. Guimarães, Bibiana de S. Boger, Gabriela P. Coral" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Suyan G.R. dos" "apellidos" => "Santos" ] 1 => array:2 [ "nombre" => "Angelo A." "apellidos" => "Mattos" ] 2 => array:2 [ "nombre" => "Marcela M." "apellidos" => "Guimarães" ] 3 => array:2 [ "nombre" => "Bibiana de S." "apellidos" => "Boger" ] 4 => array:4 [ "nombre" => "Gabriela P." "apellidos" => "Coral" "email" => array:1 [ 0 => "g.coral@terra.com.br" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Postgraduate Program in Medicine: Hepatology, Universidade Federal de Ciencias da Saúde de Porto Alegre, Porto Alegre, RS, Brazil." "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionExcessive alcohol consumption is a public health concern worldwide. An estimated 4.9% of the world’s adult population suffer from alcohol use disorder.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In the United States, alcohol abuse led to approximately 88,000 deaths each year.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In a study in Brazil, 8.9% of males and 3.6% of females had diagnosis of alcohol use disorders.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Excessive alcohol intake is a major risk factor for chronic liver disease and decompensation.<a class="elsevierStyleCrossRefs" href="#bib0020">4</a>–<a class="elsevierStyleCrossRef" href="#bib0030">6</a> In addition, patients with compensated cirrhosis may develop acute-on-chronic liver failure (ACLF) that is associated with a high mortality rate.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Moreau, et al., in a multicenter study involving 1,343 patients showed that alcohol and infection were the main precipitant factor of ACLF.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Alcoholic liver disease (ALD) accounts for 40% of all deaths from cirrhosis and is a major preventable cause of morbidity and mortality worldwide.<a class="elsevierStyleCrossRefs" href="#bib0050">10</a>–<a class="elsevierStyleCrossRef" href="#bib0060">12</a> In Brazil, a previous study in our center assess the national impact of liver diseases on hospital admissions and mortality and found that cirrhosis was the leading cause of hospitalization and death in patients with liver disease. Alcoholism was the second most common cause of cirrhosis in the country.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Despite the importance of this issue, studies investigating the influence of alcohol abuse on the outcome and prognosis of patients admitted to hepatology wards are scarce. Therefore, the aim of the present study was to determine the prevalence of alcohol consumption among hospitalized cirrhotic patients in a tertiary care hospital and its influence on clinical outcomes and mortality.Material and MethodsWe conducted a cross-sectional study with retrospective medical record review of all patients with liver cirrhosis who were admitted between January 2009 and December 2014 to the hepatology ward of Irmandade Santa Casa de Misericórdia, a tertiary care hospital and referral center for liver disease located in Porto Alegre, in southern Brazil.For comparison purposes, patients were categorized according to their alcohol consumption as alcoholic (alcohol consumption of more than 20 g/day for women and 40 g/day for men) and nonalcoholic patients. Data on daily and weekly alcohol intake (dose/g) and type of beverage consumed (sugarcane liquor, beer, wine, vodka, brandy, and whiskey) were collected from alcoholic patients.The following data were collected from all patients: sex and age, number of hospitalizations in the past 6 years, associated conditions, smoking status, diabetes mellitus, high blood pressure, HCV infection, human immunodeficiency virus (HIV) infection, clinical outcomes (ascites, hepatic encephalopathy [HE], upper gastrointestinal bleeding [UGIB], jaundice, hepatocellular carcinoma [HCC], alcoholic hepatitis, renal failure, and infection) and death. If present, infection was identified as spontaneous bacterial peritonitis (SBP), respiratory tract infection, urinary tract infection (UTI), positive blood cultures, and cutaneous or subcutaneous infections.The study was approved by the institutional review board (IRB No. 1.351.101).Continuous variables were expressed as mean (SD), and categorical variables as absolute frequencies and percentages. Mean values were compared between groups using Student’s t test, and percentages were compared using Pearson’s chi-square test. Multivariate Poisson regression was used to control for potential confounders. Prevalence ratios (PR) with 95% confidence intervals were used as effect measures. The level of significance was set at 5% (P ≤ 0.05), and all analyses were performed using SPSS, version 21.0.ResultsThe sample consisted of388 patients; 259 (66.7%) men and 129 (33.3%) women. The characteristics of the sample and their clinical outcomes, stratified based on alcohol consumption are shown <a class="elsevierStyleCrossRef" href="#t0005">table 1</a>. Of the total sample, 152 (39.2%) patients were classified as alcoholic and 236 (60.8%) as nonalcoholic. The mean (SD) age of alcoholic patients was 55.6 ± 8.9 years. Most alcoholic patients were men (n = 144; 94.7%). Alcoholic patients were readmitted more frequently than nonalcoholic patients (P < 0.001).<elsevierMultimedia ident="t0005"></elsevierMultimedia>The alcoholic group consumed a mean of 187 g of alcohol per day (SD, 165 g; median, 140 g; range, 26 to 992 g). Most of these patients consumed sugarcane liquor (57.0%), followed by beer (31.0%), vodka (1.6%), wine (5.8%), brandy (3.0%), and whiskey (1.6%).Regarding associated conditions, smoking (26.0% vs. 3.7%; p < 0.001) and high blood pressure (37.4% vs. 24.1%; p = 0.003) were more prevalent in alcoholic than in nonalcoholic patients. Diabetes mellitus, HCV infection and HIV infection did not differ statistically between groups.Twenty-two alcoholic patients had alcoholic hepatitis (17.3%). Complications associated with cirrhosis were also more frequent in alcoholic patients. Ascites was the most common complication followed by HE, UGIB and HCC. Infections occurred in 200 (51.5%) patients and were also more frequent in alcoholic; however, the analysis of infection sites revealed that only respiratory tract infections and SBP were significantly more frequent in the alcoholic group.The overall in-hospital mortality rate was 11.3% (44 of 388 patients). Twenty-two patients (14.6%) died in the alcoholic group, while 22 patients (9.3%) died in the nonalcoholic group (P = 0.155). Among alcoholic patients, 11 died of sepsis (50.0%), 5 of advanced HCC (22.8%), 2 of UGIB (9.0%), 3 of liver failure (13.7%), and 1 of acute pulmonary edema (4.5%). Among alcoholic patients who died, 3 had alcoholic hepatitis (2 died of liver failure and 1 of sepsis).<a class="elsevierStyleCrossRef" href="#t0010">Table 2</a> shows the results of the multivariate Poisson regression analysis for the influence of alcohol consumption on outcomes. The regression model was adjusted for sex, age, smoking and HCV infection. All outcomes (ascites, HE, UGIB, infection, renal failure and death) except HCC were significantly associated with alcohol consumption. Alcoholic patients were 1.67 times more likely to develop ascites (P < 0.001), 1.68 times more likely to develop HE (P = 0.006), 2.51 times more likely to have UGIB (P < 0.001), 2.14 times more likely to develop infections (P < 0.001), 1.62 times more likely to develop renal failure (P = 0.034), and 2.40 times more likely to die (P = 0.009). We also did a multivariate Poisson regression analysis to investigate the influence of HCV infection on clinical outcomes in the alcoholic cirrhotic patients, and demonstrated that only HCC was different between the groups, being more frequent in alcoholic patients with HCV (47.9% vs. 19.0%); OR 2.47 (1.39-4.39); P = 0.002.<elsevierMultimedia ident="t0010"></elsevierMultimedia>DiscussionExcessive alcohol consumption is a major cause of liver disease worldwide.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>,<a class="elsevierStyleCrossRef" href="#bib0030">6</a>,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> In a recent European study, alcoholic cirrhosis was the leading cause of hospitalization and liver cirrhosis was the main cause of death in patients with liver disease.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Similarly, in a population-based study of 16 countries across the Americas, alcohol was an important risk factor for mortality.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> In the present study, of a total sample of 388 patients, 39.2% were alcoholic. This rate is probably a reflection of our selected sample, which consisted of patients admitted to a referral center for liver disease. In a cohort study performed at 21 centers in Spain, of a total sample of 1,039 patients hospitalized in internal medicine wards, 12% had a history of alcohol abuse.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> The excessive alcohol consumption associated with males is consistent with the literature.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>,<a class="elsevierStyleCrossRefs" href="#bib0090">18</a>–<a class="elsevierStyleCrossRef" href="#bib0100">20</a>Regarding hospital readmission rates, Berman, et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> analyzed 554 admissions of patients with advanced liver disease and found, similarly to the present study, that the hospitalization rate was higher in patients with ALD than in nonalcoholic patients.In the present study, mean daily alcohol consumption was 187 g in alcoholic patients and may have contributed to the higher prevalence of liver cirrhosis decompensation, including mortality, in this group of patients. Studies showed that alcohol consumption is associated with an increased risk of death due to liver cirrhosis. The most commonly consumed alcoholic beverage in the present study was sugarcane liquor (“cachaça”). Due to its low production cost, sugarcane liquor is the most widely produced liquor in Brazil, thus being consumed in large quantities by individuals of low socioeconomic status.<a class="elsevierStyleCrossRefs" href="#bib0110">22</a>–<a class="elsevierStyleCrossRef" href="#bib0120">24</a>In addition to chronic liver disease, alcohol consumption may also cause alcoholic hepatitis, a severe complication with an acute onset and poor prognosis.<a class="elsevierStyleCrossRefs" href="#bib0125">25</a>–<a class="elsevierStyleCrossRef" href="#bib0135">27</a> In the present study, 22 patients (13.7%) had alcoholic hepatitis.Pessione, et al., evaluating 5-year predictive factors in hospitalized patients with excessive alcohol intake and cirrhosis, found an association between smoking and mortality.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> In the present study, smoking was more common in alcoholic patients, which is consistent with previous studies.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>,<a class="elsevierStyleCrossRef" href="#bib0140">28</a> Mortality remained associated with excessive alcohol consumption even after controlling for smoking in the multivariate analysis. Excessive alcohol consumption was also associated with high blood pressure in hospitalized patients. A similar association was also reported in the literatura.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>The prevalence of HCV infection is higher in alcoholic patients than in the general population, ranging from 2 to 51%.<a class="elsevierStyleCrossRefs" href="#bib0155">31</a>–<a class="elsevierStyleCrossRef" href="#bib0170">34</a> In a systematic review, Veleiro, et al. reported a prevalence of 16.32% of HCV infection in patients with excessive alcohol use,<a class="elsevierStyleCrossRef" href="#bib0165">33</a> while, in the general population, the prevalence was approximately 2%.<a class="elsevierStyleCrossRef" href="#bib0160">32</a>,<a class="elsevierStyleCrossRefs" href="#bib0170">34</a>–<a class="elsevierStyleCrossRef" href="#bib0180">36</a> Alcohol has a negative impact on the progression of chronic HCV infection due to a synergistic effect that increases viral replication and alters the immune response.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>,<a class="elsevierStyleCrossRef" href="#bib0185">37</a> In this study the occurrence of HCV infection was similar between groups.In the present study, we only considered patients with liver cirrhosis. The literature shows that individuals who consume more than 25 g of alcohol per day have an increased relative risk of cirrosis.<a class="elsevierStyleCrossRef" href="#bib0190">38</a> The risk of developing alcoholic cirrhosis was higher in daily drinkers than in those drinking 2-4 days/week.<a class="elsevierStyleCrossRef" href="#bib0195">39</a>Portal hypertension and its manifestations (ascites, HE, and UGIB) are common complications of liver cirrosis.<a class="elsevierStyleCrossRef" href="#bib0200">40</a>,<a class="elsevierStyleCrossRef" href="#bib0205">41</a> In the present study, ascites, HE and UGIB were more frequent in alcoholic patients. Jepsen, et al. examined the clinical course of alcoholic cirrhosis in 466 patients; as in the present study, ascites was the most common complication of cirrhosis.<a class="elsevierStyleCrossRef" href="#bib0210">42</a>HCC is another common complication of liver cirrosis.<a class="elsevierStyleCrossRefs" href="#bib0215">43</a>–<a class="elsevierStyleCrossRef" href="#bib0235">47</a> Mancebo, et al., investigating 450 patients with alcoholic cirrhosis reported an annual incidence of HCC of 2.6%.<a class="elsevierStyleCrossRef" href="#bib0230">46</a> Alcohol consumption and HCV infection have a synergistic effect on the predisposition to HCC.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>,<a class="elsevierStyleCrossRef" href="#bib0185">37</a> In the present study, 141 patients (36.3%) had a diagnosis of HCC however its occurrence was similar between alcoholics and non-alcoholics. On the other hand, when we analyzed only the alcoholic cirrhotic patients, we demonstrated that the presence of HCV in this population was associated with HCC.Despite recent advances in the treatment of cirrhosis, bacterial infections remain an important complication that affects approximately 30% of patients, leading to increased mortality. The mechanism of infection is multifactorial and the incidence of resistant bacteria has increased, especially in hospitalized patients.<a class="elsevierStyleCrossRef" href="#bib0240">48</a>,<a class="elsevierStyleCrossRef" href="#bib0245">49</a> In the present study, the overall infection rate was 51.5%. Infections were more frequent in alcoholic (73.0%) than in nonalcoholic (37.7%) patients, and the most frequent infections are SBP, respiratory tract infections, and UTI, which is consistent with previous studies.<a class="elsevierStyleCrossRef" href="#bib0240">48</a>,<a class="elsevierStyleCrossRef" href="#bib0245">49</a>In the present study, the overall mortality rate was 11.3% and excessive alcohol use increased the risk of death by 2.4 times. Regarding mortality in Brazil, Garcia, et al. reviewed the data from the Mortality Information System of the Brazilian Ministry of Health between 2010 and 2012 and identified 55,380 deaths attributable to alcohol-related conditions. Liver disease was the main cause of death (55.3%) and the overall mortality rate was 8.7 times higher in males than in females.<a class="elsevierStyleCrossRef" href="#bib0250">50</a>ConclusionThis study showed that alcohol consumption was a frequent finding among patients admitted to a referral center for liver disease. Excessive alcohol use was also a predictor of severe liver disease and its complications, increasing the risk of infection and death in hospitalized patients.Abbreviations<ul class="elsevierStyleList" id="l0004"><li class="elsevierStyleListItem" id="u0005">•ACLF: acute-on-chronic liver failure.</li><li class="elsevierStyleListItem" id="u0010">•ALD: alcoholic liver disease.</li><li class="elsevierStyleListItem" id="u0015">•HCV: hepatitis C virus.</li><li class="elsevierStyleListItem" id="u0020">•HCC: hepatocellular carcinoma.</li><li class="elsevierStyleListItem" id="u0025">•HE: hepatic encephalopathy.</li><li class="elsevierStyleListItem" id="u0030">•HIV: human immunodeficiency virus.</li><li class="elsevierStyleListItem" id="u0035">•SBP: spontaneous bacterial peritonitis.</li><li class="elsevierStyleListItem" id="u0040">•UGIB: upper gastrointestinal bleeding.</li><li class="elsevierStyleListItem" id="u0045">•UTI: urinary tract infection</li></ul>Financial DisclosureThe authors have no financial relationships to this article to disclose.Conflict of InterestThe authors have no conflicts of interest to disclose." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1190768" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abs0010" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1110045" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "s0010" "titulo" => "Material and Methods" ] 4 => array:2 [ "identificador" => "s0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "s0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "s0025" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "s0030" "titulo" => "Abbreviations" ] 8 => array:2 [ "identificador" => "s0035" "titulo" => "Financial Disclosure" ] 9 => array:2 [ "identificador" => "s0040" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-15" "fechaAceptado" => "2017-08-28" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1110045" "palabras" => array:4 [ 0 => "Alcoholism" 1 => "Hepatic disease" 2 => "Infection" 3 => "In-hospital mortality" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Introduction and aim. Excessive alcohol consumption is a public health concern worldwide and has been associated with high mortality rates. This study aimed to determine the prevalence of alcohol consumption and its influence on the prognosis of hospitalized cirrhotic patients in a tertiary care hospital.Material and methods. We reviewed the medical records of all patients with hepatic cirrhosis admitted between January 2009 and December 2014, in a referral center for liver disease in southern Brazil. Data on clinical outcomes, associated conditions, infections, and mortality were collected and compared between alcoholic and nonalcoholic patients.Results. The sample consisted of 388 patients; 259 (66.7%) were men. One hundred fifty-two (39.2%) were classified as heavy use of alcohol. Most alcoholic patients were men (n = 144; 94.7%). Mean age was 55.6 ± 8.9 years. Hepatic decompensations and infections were more prevalent in alcoholic patient. Spontaneous bacterial peritonitis and respiratory tract infection accounted for most of the infections. Excessive alcohol consumption was associated with mortality (P = 0.009) in multivariate analysis.Conclusion. On the present study, the prevalence of heavy use of alcohol was high and associated with a poorer prognosis in hospitalized cirrhotic patients, increasing the risk of infection and death." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "t0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "HCC: hepatocellular carcinoma. HE: hepatic encephalopathy. SBP: spontaneous bacterial peritonitis. UGIB: upper gastrointestinal bleeding." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alcoholic (n = 152; 39.2%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nonalcoholic (n = 236;60.8%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) - mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.6 ± 8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.7 ± 12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.051 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex - n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">144 (94.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 (48.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">121 (51.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ascites \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 (65.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 (41.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (41.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54 (22.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UGIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (36.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (12.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jaundice \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (34.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (36.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 (36.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.955 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.394 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 (73.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 (37.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 (65.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (18.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (20.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (9.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (13.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.417 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive blood culture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.416 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cutaneous/subcutaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (3.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.381 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death - n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.155 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2031848.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics and clinical outcomes." ] ] 1 => array:7 [ "identificador" => "t0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "HCC: hepatocellular carcinoma. HE: hepatic encephalopathy. PR: prevalence ratio. UGIB: upper gastrointestinal bleeding." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcomes \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PR adjusted<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> (95%CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ascites \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.67 (1.31-2.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.68 (1.16-2.43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UGIB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.51 (1.53-4.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.99 (0.73-1.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.954 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.14 (1.67-2.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.62 (1.04-2.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.034 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.40 (1.24-4.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2031849.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "adjusted for age, sex, smoking status, and hepatitis C virus." ] ] ] "descripcion" => array:1 [ "en" => "Results of multivariate Poisson regression analysis for the influence of alcohol consumption on clinical outcomes." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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Suyan G.R. dos Santos, Angelo A. Mattos, Marcela M. Guimarães, Bibiana de S. Boger, Gabriela P. Coral

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g.coral@terra.com.br

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Postgraduate Program in Medicine: Hepatology, Universidade Federal de Ciencias da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Excessive alcohol consumption is a public health concern worldwide&#46; An estimated 4&#46;9&#37; of the world&#8217;s adult population suffer from alcohol use disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the United States&#44; alcohol abuse led to approximately 88&#44;000 deaths each year&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In a study in Brazil&#44; 8&#46;9&#37; of males and 3&#46;6&#37; of females had diagnosis of alcohol use disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Excessive alcohol intake is a major risk factor for chronic liver disease and decompensation&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In addition&#44; patients with compensated cirrhosis may develop acute-on-chronic liver failure &#40;ACLF&#41; that is associated with a high mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Moreau&#44; <span class="elsevierStyleItalic">et al&#46;</span>&#44; in a multicenter study involving 1&#44;343 patients showed that alcohol and infection were the main precipitant factor of ACLF&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Alcoholic liver disease &#40;ALD&#41; accounts for 40&#37; of all deaths from cirrhosis and is a major preventable cause of morbidity and mortality worldwide&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In Brazil&#44; a previous study in our center assess the national impact of liver diseases on hospital admissions and mortality and found that cirrhosis was the leading cause of hospitalization and death in patients with liver disease&#46; Alcoholism was the second most common cause of cirrhosis in the country&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">Despite the importance of this issue&#44; studies investigating the influence of alcohol abuse on the outcome and prognosis of patients admitted to hepatology wards are scarce&#46; Therefore&#44; the aim of the present study was to determine the prevalence of alcohol consumption among hospitalized cirrhotic patients in a tertiary care hospital and its influence on clinical outcomes and mortality&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Material and Methods</span><p id="p0025" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional study with retrospective medical record review of all patients with liver cirrhosis who were admitted between January 2009 and December 2014 to the hepatology ward of Irmandade Santa Casa de Miseric&#243;rdia&#44; a tertiary care hospital and referral center for liver disease located in Porto Alegre&#44; in southern Brazil&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">For comparison purposes&#44; patients were categorized according to their alcohol consumption as alcoholic &#40;alcohol consumption of more than 20 g&#47;day for women and 40 g&#47;day for men&#41; and nonalcoholic patients&#46; Data on daily and weekly alcohol intake &#40;dose&#47;g&#41; and type of beverage consumed &#40;sugarcane liquor&#44; beer&#44; wine&#44; vodka&#44; brandy&#44; and whiskey&#41; were collected from alcoholic patients&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">The following data were collected from all patients&#58; sex and age&#44; number of hospitalizations in the past 6 years&#44; associated conditions&#44; smoking status&#44; diabetes mellitus&#44; high blood pressure&#44; HCV infection&#44; human immunodeficiency virus &#40;HIV&#41; infection&#44; clinical outcomes &#40;ascites&#44; hepatic encephalopathy &#91;HE&#93;&#44; upper gastrointestinal bleeding &#91;UGIB&#93;&#44; jaundice&#44; hepatocellular carcinoma &#91;HCC&#93;&#44; alcoholic hepatitis&#44; renal failure&#44; and infection&#41; and death&#46; If present&#44; infection was identified as spontaneous bacterial peritonitis &#40;SBP&#41;&#44; respiratory tract infection&#44; urinary tract infection &#40;UTI&#41;&#44; positive blood cultures&#44; and cutaneous or subcutaneous infections&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">The study was approved by the institutional review board &#40;IRB No&#46; 1&#46;351&#46;101&#41;&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">Continuous variables were expressed as mean &#40;SD&#41;&#44; and categorical variables as absolute frequencies and percentages&#46; Mean values were compared between groups using Student&#8217;s t test&#44; and percentages were compared using Pearson&#8217;s chi-square test&#46; Multivariate Poisson regression was used to control for potential confounders&#46; Prevalence ratios &#40;PR&#41; with 95&#37; confidence intervals were used as effect measures&#46; The level of significance was set at 5&#37; &#40;P &#8804; 0&#46;05&#41;&#44; and all analyses were performed using SPSS&#44; version 21&#46;0&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Results</span><p id="p0050" class="elsevierStylePara elsevierViewall">The sample consisted of388 patients&#59; 259 &#40;66&#46;7&#37;&#41; men and 129 &#40;33&#46;3&#37;&#41; women&#46; The characteristics of the sample and their clinical outcomes&#44; stratified based on alcohol consumption are shown <a class="elsevierStyleCrossRef" href="#t0005">table 1</a>&#46; Of the total sample&#44; 152 &#40;39&#46;2&#37;&#41; patients were classified as alcoholic and 236 &#40;60&#46;8&#37;&#41; as nonalcoholic&#46; The mean &#40;SD&#41; age of alcoholic patients was 55&#46;6 &#177; 8&#46;9 years&#46; Most alcoholic patients were men &#40;n &#61; 144&#59; 94&#46;7&#37;&#41;&#46; Alcoholic patients were readmitted more frequently than nonalcoholic patients &#40;P &#60; 0&#46;001&#41;&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0055" class="elsevierStylePara elsevierViewall">The alcoholic group consumed a mean of 187 g of alcohol per day &#40;SD&#44; 165 g&#59; median&#44; 140 g&#59; range&#44; 26 to 992 g&#41;&#46; Most of these patients consumed sugarcane liquor &#40;57&#46;0&#37;&#41;&#44; followed by beer &#40;31&#46;0&#37;&#41;&#44; vodka &#40;1&#46;6&#37;&#41;&#44; wine &#40;5&#46;8&#37;&#41;&#44; brandy &#40;3&#46;0&#37;&#41;&#44; and whiskey &#40;1&#46;6&#37;&#41;&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">Regarding associated conditions&#44; smoking &#40;26&#46;0&#37; <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;7&#37;&#59; p &#60; 0&#46;001&#41; and high blood pressure &#40;37&#46;4&#37; <span class="elsevierStyleItalic">vs&#46;</span> 24&#46;1&#37;&#59; p &#61; 0&#46;003&#41; were more prevalent in alcoholic than in nonalcoholic patients&#46; Diabetes mellitus&#44; HCV infection and HIV infection did not differ statistically between groups&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">Twenty-two alcoholic patients had alcoholic hepatitis &#40;17&#46;3&#37;&#41;&#46; Complications associated with cirrhosis were also more frequent in alcoholic patients&#46; Ascites was the most common complication followed by HE&#44; UGIB and HCC&#46; Infections occurred in 200 &#40;51&#46;5&#37;&#41; patients and were also more frequent in alcoholic&#59; however&#44; the analysis of infection sites revealed that only respiratory tract infections and SBP were significantly more frequent in the alcoholic group&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">The overall in-hospital mortality rate was 11&#46;3&#37; &#40;44 of 388 patients&#41;&#46; Twenty-two patients &#40;14&#46;6&#37;&#41; died in the alcoholic group&#44; while 22 patients &#40;9&#46;3&#37;&#41; died in the nonalcoholic group &#40;P &#61; 0&#46;155&#41;&#46; Among alcoholic patients&#44; 11 died of sepsis &#40;50&#46;0&#37;&#41;&#44; 5 of advanced HCC &#40;22&#46;8&#37;&#41;&#44; 2 of UGIB &#40;9&#46;0&#37;&#41;&#44; 3 of liver failure &#40;13&#46;7&#37;&#41;&#44; and 1 of acute pulmonary edema &#40;4&#46;5&#37;&#41;&#46; Among alcoholic patients who died&#44; 3 had alcoholic hepatitis &#40;2 died of liver failure and 1 of sepsis&#41;&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t0010">Table 2</a> shows the results of the multivariate Poisson regression analysis for the influence of alcohol consumption on outcomes&#46; The regression model was adjusted for sex&#44; age&#44; smoking and HCV infection&#46; All outcomes &#40;ascites&#44; HE&#44; UGIB&#44; infection&#44; renal failure and death&#41; except HCC were significantly associated with alcohol consumption&#46; Alcoholic patients were 1&#46;67 times more likely to develop ascites &#40;P &#60; 0&#46;001&#41;&#44; 1&#46;68 times more likely to develop HE &#40;P &#61; 0&#46;006&#41;&#44; 2&#46;51 times more likely to have UGIB &#40;P &#60; 0&#46;001&#41;&#44; 2&#46;14 times more likely to develop infections &#40;P &#60; 0&#46;001&#41;&#44; 1&#46;62 times more likely to develop renal failure &#40;P &#61; 0&#46;034&#41;&#44; and 2&#46;40 times more likely to die &#40;P &#61; 0&#46;009&#41;&#46; We also did a multivariate Poisson regression analysis to investigate the influence of HCV infection on clinical outcomes in the alcoholic cirrhotic patients&#44; and demonstrated that only HCC was different between the groups&#44; being more frequent in alcoholic patients with HCV &#40;47&#46;9&#37; <span class="elsevierStyleItalic">vs&#46;</span> 19&#46;0&#37;&#41;&#59; OR 2&#46;47 &#40;1&#46;39-4&#46;39&#41;&#59; P &#61; 0&#46;002&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Discussion</span><p id="p0080" class="elsevierStylePara elsevierViewall">Excessive alcohol consumption is a major cause of liver disease worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In a recent European study&#44; alcoholic cirrhosis was the leading cause of hospitalization and liver cirrhosis was the main cause of death in patients with liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Similarly&#44; in a population-based study of 16 countries across the Americas&#44; alcohol was an important risk factor for mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In the present study&#44; of a total sample of 388 patients&#44; 39&#46;2&#37; were alcoholic&#46; This rate is probably a reflection of our selected sample&#44; which consisted of patients admitted to a referral center for liver disease&#46; In a cohort study performed at 21 centers in Spain&#44; of a total sample of 1&#44;039 patients hospitalized in internal medicine wards&#44; 12&#37; had a history of alcohol abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The excessive alcohol consumption associated with males is consistent with the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="p0085" class="elsevierStylePara elsevierViewall">Regarding hospital readmission rates&#44; Berman&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> analyzed 554 admissions of patients with advanced liver disease and found&#44; similarly to the present study&#44; that the hospitalization rate was higher in patients with ALD than in nonalcoholic patients&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">In the present study&#44; mean daily alcohol consumption was 187 g in alcoholic patients and may have contributed to the higher prevalence of liver cirrhosis decompensation&#44; including mortality&#44; in this group of patients&#46; Studies showed that alcohol consumption is associated with an increased risk of death due to liver cirrhosis&#46; The most commonly consumed alcoholic beverage in the present study was sugarcane liquor &#40;&#8220;cacha&#231;a&#8221;&#41;&#46; Due to its low production cost&#44; sugarcane liquor is the most widely produced liquor in Brazil&#44; thus being consumed in large quantities by individuals of low socioeconomic status&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="p0095" class="elsevierStylePara elsevierViewall">In addition to chronic liver disease&#44; alcohol consumption may also cause alcoholic hepatitis&#44; a severe complication with an acute onset and poor prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In the present study&#44; 22 patients &#40;13&#46;7&#37;&#41; had alcoholic hepatitis&#46;</p><p id="p0100" class="elsevierStylePara elsevierViewall">Pessione&#44; <span class="elsevierStyleItalic">et al&#46;</span>&#44; evaluating 5-year predictive factors in hospitalized patients with excessive alcohol intake and cirrhosis&#44; found an association between smoking and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In the present study&#44; smoking was more common in alcoholic patients&#44; which is consistent with previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Mortality remained associated with excessive alcohol consumption even after controlling for smoking in the multivariate analysis&#46; Excessive alcohol consumption was also associated with high blood pressure in hospitalized patients&#46; A similar association was also reported in the literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="p0105" class="elsevierStylePara elsevierViewall">The prevalence of HCV infection is higher in alcoholic patients than in the general population&#44; ranging from 2 to 51&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> In a systematic review&#44; Veleiro&#44; <span class="elsevierStyleItalic">et al&#46;</span> reported a prevalence of 16&#46;32&#37; of HCV infection in patients with excessive alcohol use&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> while&#44; in the general population&#44; the prevalence was approximately 2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Alcohol has a negative impact on the progression of chronic HCV infection due to a synergistic effect that increases viral replication and alters the immune response&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> In this study the occurrence of HCV infection was similar between groups&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">In the present study&#44; we only considered patients with liver cirrhosis&#46; The literature shows that individuals who consume more than 25 g of alcohol per day have an increased relative risk of cirrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> The risk of developing alcoholic cirrhosis was higher in daily drinkers than in those drinking 2-4 days&#47;week&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="p0115" class="elsevierStylePara elsevierViewall">Portal hypertension and its manifestations &#40;ascites&#44; HE&#44; and UGIB&#41; are common complications of liver cirrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> In the present study&#44; ascites&#44; HE and UGIB were more frequent in alcoholic patients&#46; Jepsen&#44; et al&#46; examined the clinical course of alcoholic cirrhosis in 466 patients&#59; as in the present study&#44; ascites was the most common complication of cirrhosis&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p><p id="p0120" class="elsevierStylePara elsevierViewall">HCC is another common complication of liver cirrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> Mancebo&#44; <span class="elsevierStyleItalic">et al&#46;</span>&#44; investigating 450 patients with alcoholic cirrhosis reported an annual incidence of HCC of 2&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> Alcohol consumption and HCV infection have a synergistic effect on the predisposition to HCC&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> In the present study&#44; 141 patients &#40;36&#46;3&#37;&#41; had a diagnosis of HCC however its occurrence was similar between alcoholics and non-alcoholics&#46; On the other hand&#44; when we analyzed only the alcoholic cirrhotic patients&#44; we demonstrated that the presence of HCV in this population was associated with HCC&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">Despite recent advances in the treatment of cirrhosis&#44; bacterial infections remain an important complication that affects approximately 30&#37; of patients&#44; leading to increased mortality&#46; The mechanism of infection is multifactorial and the incidence of resistant bacteria has increased&#44; especially in hospitalized patients&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> In the present study&#44; the overall infection rate was 51&#46;5&#37;&#46; Infections were more frequent in alcoholic &#40;73&#46;0&#37;&#41; than in nonalcoholic &#40;37&#46;7&#37;&#41; patients&#44; and the most frequent infections are SBP&#44; respiratory tract infections&#44; and UTI&#44; which is consistent with previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p><p id="p0130" class="elsevierStylePara elsevierViewall">In the present study&#44; the overall mortality rate was 11&#46;3&#37; and excessive alcohol use increased the risk of death by 2&#46;4 times&#46; Regarding mortality in Brazil&#44; Garcia&#44; <span class="elsevierStyleItalic">et al&#46;</span> reviewed the data from the Mortality Information System of the Brazilian Ministry of Health between 2010 and 2012 and identified 55&#44;380 deaths attributable to alcohol-related conditions&#46; Liver disease was the main cause of death &#40;55&#46;3&#37;&#41; and the overall mortality rate was 8&#46;7 times higher in males than in females&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a></p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Conclusion</span><p id="p0135" class="elsevierStylePara elsevierViewall">This study showed that alcohol consumption was a frequent finding among patients admitted to a referral center for liver disease&#46; Excessive alcohol use was also a predictor of severe liver disease and its complications&#44; increasing the risk of infection and death in hospitalized patients&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Abbreviations</span><p id="p0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0004"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ACLF&#58;</span> acute-on-chronic liver failure&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ALD&#58;</span> alcoholic liver disease&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HCV&#58;</span> hepatitis C virus&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HCC&#58;</span> hepatocellular carcinoma&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HE&#58;</span> hepatic encephalopathy&#46;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HIV&#58;</span> human immunodeficiency virus&#46;</p></li><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">SBP&#58;</span> spontaneous bacterial peritonitis&#46;</p></li><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">UGIB&#58;</span> upper gastrointestinal bleeding&#46;</p></li><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">UTI&#58;</span> urinary tract infection</p></li></ul></p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Financial Disclosure</span><p id="p0190" class="elsevierStylePara elsevierViewall">The authors have no financial relationships to this article to disclose&#46;</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Conflict of Interest</span><p id="p0195" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to disclose&#46;</p></span></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction and aim&#46;</span> Excessive alcohol consumption is a public health concern worldwide and has been associated with high mortality rates&#46; This study aimed to determine the prevalence of alcohol consumption and its influence on the prognosis of hospitalized cirrhotic patients in a tertiary care hospital&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods&#46;</span> We reviewed the medical records of all patients with hepatic cirrhosis admitted between January 2009 and December 2014&#44; in a referral center for liver disease in southern Brazil&#46; Data on clinical outcomes&#44; associated conditions&#44; infections&#44; and mortality were collected and compared between alcoholic and nonalcoholic patients&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#46;</span> The sample consisted of 388 patients&#59; 259 &#40;66&#46;7&#37;&#41; were men&#46; One hundred fifty-two &#40;39&#46;2&#37;&#41; were classified as heavy use of alcohol&#46; Most alcoholic patients were men &#40;n &#61; 144&#59; 94&#46;7&#37;&#41;&#46; Mean age was 55&#46;6 &#177; 8&#46;9 years&#46; Hepatic decompensations and infections were more prevalent in alcoholic patient&#46; Spontaneous bacterial peritonitis and respiratory tract infection accounted for most of the infections&#46; Excessive alcohol consumption was associated with mortality &#40;P &#61; 0&#46;009&#41; in multivariate analysis&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusion&#46;</span> On the present study&#44; the prevalence of heavy use of alcohol was high and associated with a poorer prognosis in hospitalized cirrhotic patients&#44; increasing the risk of infection and death&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "t0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="np0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">HCC&#58; hepatocellular carcinoma&#46; HE&#58; hepatic encephalopathy&#46; SBP&#58; spontaneous bacterial peritonitis&#46; UGIB&#58; upper gastrointestinal bleeding</span>&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alcoholic &#40;n &#61; 152&#59; 39&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nonalcoholic &#40;n &#61; 236&#59;60&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41; - mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;6 &#177; 8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;7 &#177; 12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex - n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 &#40;94&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115 &#40;48&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;51&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;65&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97 &#40;41&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;41&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UGIB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;36&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jaundice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;34&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;36&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;36&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;955&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;394&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111 &#40;73&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;37&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;65&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;18&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Respiratory tract&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;20&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urinary tract&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;417&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive blood culture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;416&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Cutaneous&#47;subcutaneous&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 16652681
Original language: English

DOI:10.5604/01.3001.0011.7391

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Year/Month	Html	Pdf	Total

2024 November	4	0	4
2024 October	13	8	21
2024 September	12	10	22
2024 August	17	4	21
2024 July	15	4	19
2024 June	25	7	32
2024 May	28	7	35
2024 April	51	6	57
2024 March	19	4	23
2024 February	7	7	14
2024 January	19	7	26
2023 December	11	5	16
2023 November	5	3	8
2023 October	19	18	37
2023 September	8	3	11
2023 August	18	7	25
2023 July	12	5	17
2023 June	16	4	20
2023 May	51	7	58
2023 April	76	9	85
2023 March	34	3	37
2023 February	25	9	34
2023 January	28	11	39
2022 December	14	8	22
2022 November	9	12	21
2022 October	11	10	21
2022 September	9	9	18
2022 August	17	13	30
2022 July	9	8	17
2022 June	12	6	18
2022 May	9	6	15
2022 April	13	11	24
2022 March	15	9	24
2022 February	9	4	13
2022 January	16	8	24
2021 December	40	8	48
2021 November	16	7	23
2021 October	12	10	22
2021 September	7	14	21
2021 August	10	2	12
2021 July	6	9	15
2021 June	10	7	17
2021 May	8	10	18
2021 April	28	10	38
2021 March	18	7	25
2021 February	7	7	14
2021 January	6	9	15
2020 December	15	16	31
2020 November	22	11	33
2020 October	10	4	14
2020 September	8	13	21
2020 August	15	8	23
2020 July	12	10	22
2020 June	14	3	17
2020 May	14	9	23
2020 April	9	5	14
2020 March	13	4	17
2020 February	17	6	23
2020 January	7	2	9
2019 December	13	6	19
2019 November	15	7	22
2019 October	9	2	11
2019 September	7	4	11
2019 August	6	2	8
2019 July	4	12	16
2019 June	23	8	31
2019 May	38	13	51

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