O-6 EXPLORING THE IMPACT OF INFECTIONS IN PATIENTS WITH ALCOHOL- ASSOCIATED HEPATITIS IN LATIN AMERICA

Introduction and Methods

Severe alcohol-associated hepatitis (AH) is frequently associated with higher infection risk. This study aimed to assess the impact of infections in patients with AH in a multinational cohort in Latin America.

Materials and Methods

Multicenter prospective cohort study including patients with AH (2015-2022). We recorded clinical information, and the impact of infections was assessed using competing-risk models.

Results

We included 511 patients from 24 centers in 8 countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru). The mean age was 50.1±11.9 years, 426 (83.9%) were men, 264 (58.2%) had a previous diagnosis of cirrhosis, and the median MELD at diagnosis was 24.6 [19.6–30.6] points. Out of the total, 25.9% died, and only 3.7% underwent liver transplantation during follow-up. Also, 44.5% of patients developed an infection. Of them, 50.9% presented with infection at admission, 30.8% developed an infection during hospitalization, and 18.3% presented an infection in both situations. The most common localizations at admission were pulmonary (32.4%), urinary tract (33.1%), spontaneous bacterial peritonitis (15.9%), and cutaneous (9.7%). The main localizations during hospitalization were pulmonary (34.4%), urinary tract (25.8%), spontaneous bacterial peritonitis (14.0%), and bacteremia (8.6%%). The incidence of multidrug-resistant (MDR) organisms was 11.2% at admission and 10.3% during hospitalization, while the incidence of extensively drug-resistant (XDR) organisms was 1.4% and 4.7%, respectively. The presence of infection was associated with higher mortality (sub-distribution hazard ratio [sHR] 1.92, 95%CI:1.56–2.37; p<0.001). In a competing-risk model adjusted by age, sex, MELD, and ACLF grade, the infections were independently associated with mortality (sHR 1.33, 95%CI:1.02–1.75; p=0.037).

Conclusions

Infections during an AH episode are frequent and independently associated with mortality in Latin America. However, the incidence of multidrug-resistant organisms was lower than in other regions. Efforts should be made to prevent, diagnose, and adequately treat infections in AH.