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Liver Int. 2014 Nov;34(10):1496-503. doi: 10.1111/liv.12520. Epub 2014 Mar 26.

Impact of infection on the prognosis of critically ill cirrhotic patients: results from a large worldwide study.

Collaborators (1229)

Margarit A, Valentini R, Zazu AJ, Bevilacqua C, Curone M, Rabuffetti R, Comignani P, Torres Boden M, Chertcoff F, Cardonatti G, Adén F, Marcos L, Dónofrio M, Fernández R, Lamberghini R, Balasini S, Teves J, Las Heras M, Sinner J, Ceraso D, Curcio D, Aguilar L, Weller C, Cardonnet L, Santa Cruz R, Manrique E, Bernardez D, Iolster T, Chiappero G, Curcio D, Ramos P, Vergara J, Moine I, Ilutovich S, Jannello G, Waschbusch M, Rios Picaza G, Raimondi A, Miriam M, Carlos L, Curcio D, Caridi M, Leong T, Orford N, Reece G, Ernest D, Hawker F, Tan J, Giannellis C, Ihle B, Bersten A, McInnes J, Tallott M, Mcfadyen B, Vibert J, Parr M, Tran K, Sutton J, Webb S, Groves N, Cole L, Long D, Bass F, Erickson S, Lipman J, Long D, Delzoppo C, Thomas J, Dobb G, Daley M, Roberts B, Webb S, Santamaria J, Young J, Festa M, Holland R, Mullany D, Williams P, Corkeron M, Gales M, Banerjee A, Yung M, Mutz N, Hiesmayr M, Faybik P, Fitzgerald R, Firlinger F, Zasmeta G, Zink M, Sieber W, Hildegard J, Bakondy R, Schlieber J, Filzwieser G, Beer R, Joannidis M, Staudinger T, Schuster R, Scherzer W, Smolle K, Fitzal S, Manzoor R, Brunain J, Dive A, Huylenbroeck G, Van der Schueren M, 't kindt H, Slock E, Rijckaert D, Raemaekers J, Bourgeois M, Van Cotthem I, Nackaerts G, Gusu D, Gadisseaux P, Olivier V, Lignian H, Michel P, Fraipont V, Van der Stappen M, Forêt F, De Bels D, Devriendt J, Massaut J, Biston P, Roman A, Lambermont B, De Meulder A, Frederic V, Sottiaux T, Ruyffelaere P, Collin V, Anane S, Kleiren P, Simon M, Machayekhi S, Frans E, Leroy G, Berghmans T, Joseph R, Eerens J, Laterre PF, Lagrou B, Rutsaert R, Pisarek W, Dive A, De Waele J, Spapen H, Damas P, Vincent JL, Malbrain M, Hidalgo J, Baptista M, Salgado D, Braga M, Avila C, Westphal G, Caser E, Alves A, Friedman G, Luz M, Assuncao M, Reis H, Gomes A, Silva U, Nogueira Fh W, El-Dash S, Valiatti J, Barbosa A, Coelho C, Knibel M, Minelli C, Caovilla J, Teixeira G, Hovnanian A, Rea-Neto A, Lobo SL, Lugarinho M, Souza P, Ferreira D, Duarte P, Oliveira M, Marques J, Machado R, Rehder P, Mataloun S, Grilo M, Quesado P, Moock M, Ferreira F, Teles J, Silva E, Coelho C, Morais A, Carvalho F, Wanderley M, Velasco M, Brandão da Silva N, Feijó J, Duarte P, Souza Dantas V, Teles J, Costa Filho R, Japiassu A, Villela D, Santos C, Passos R, Alheira-Rocha R, Silva R, Houly J, Aldrighi J, Hatum R, Suparregui Dias F, Ferreira L, Ferro L, Gomez J, Fleury R, David C, Resener T, Duarte P, Mendes C, Germano A, Oliveira M, De marco F, Japiassu A, Lage S, Salluh J, Torelly A, Sad R, Barbosa A, Oliveira G, Lima R, Paranhos J, Oliveira M, Rocha M, Bitencourt W, Rea-Neto A, Grion C, Forte D, Guimarães H, Piras C, Stephanova L, Lyubenov L, Tsarianski G, Dimov G, Green R, Levasseur J, Ward R, Lesur O, Poirier G, Wax R, Wood G, Cook D, Marshall J, Herridge M, Ferguson N, Wood G, Espinoza M, Valdés jimenez S, Bruhn A, Micolich J, Galvez S, Escamilla Leon I, Zhan Q, Xu Y, Zhao Y, Zhang L, Qin T, Du B, Li M, Wang X, Jing Y, Zhang Z, Xianyao W, Li F, Congshan Y, Rebolledo C, Diaz D, Murillo Arboleda R, Rebolledo C, Arias Antun A, Montenegro G, Granados M, Duenas C, Perez N, Libreros Duque G, Coral M, Ortiz G, Rodriguez D, Barsic B, Cubrilo-Turek M, Gornik I, Grljusic M, Caballero lopez A, Iraola ferrer M, Pavlik P, Manak J, Radej J, Belohlavek J, Sevcik P, Blahut L, Tyl D, Steinbach J, Herold I, Zykova I, Prchal D, Bartosik T, Kolarova M, Hájek R, Kohoutová J, Marek O, Hon P, Chytra I, Betsch H, Fogh B, Espersen K, Jacobsen K, Berezowicz P, Guerrero F, Salgado E, Barahona D, Del pozo sanchez H, Jibaja M, Alansary A, Reintam A, Starkopf J, Harjola V, Tual L, Leone M, Serge M, Michel P, Leroy O, Mallet L, Marc B, Dormoy D, Pascal H, Tronchon L, Garrigues B, Santré C, Dupont H, Duranteau J, Leon A, Henry L, Canevet C, Dube L, Julien H, Nadia A, Francois B, Gérard J, Freysz M, Remy G, Blanloeil Y, Squara P, Korach J, Durand M, Gabriel C, Eric P, Jacobs F, Bronchard R, Kipnis E, Moussa M, Launoy A, Guérin C, Vanhems P, Wynckel A, Clair B, Azoulay E, Fulgencio J, Gottwalles Y, Krummel T, Lepape A, Lesieur O, Payen D, Hérvé O, Cougot P, Malledant Y, Joannes-Boyau O, Standl T, Sierig U, Geiseler J, Hopf H, Burgau M, Conrad-Opel E, Hermann C, Ventzke M, Henneberg T, Loeser H, Spies C, Spies C, Esposito F, Zuckermann-becker H, Scherer R, Pauer A, Kljucar S, Delfs K, Blank E, Busch J, Wendt K, Leßmann J, Busch J, Bach F, Sakr Y, Berlet T, Kernchen A, Quintel M, Holst D, Kilger E, Holubarsch T, Raufhake C, Kuhlen R, Stolt C, Lubasch A, Meier-Hellmann A, Woebker G, Scharnofske C, Breyer M, Risch T, Manhold C, Kljucar S, Meininger D, Greive C, Rau J, Seibel A, Henn-beilharz A, Wolbert R, Scherke T, Martin J, Rudolph M, Gleißner J, Wolf M, Schleibach F, Jaschinski U, Lunkeit A, Welte M, Bingold T, Sydow K, Kogelmann K, Fischer F, Fischer B, Schmid M, Klein M, Bechtold A, Bodmann K, Klasen J, Meyrl H, Goetz J, Geldner G, Helmes T, Jensen N, Eickmeyer H, Lengfelder W, Langenstein B, Bogdanski R, Jelen-Esselborn S, Umgelter A, Dörr F, Lüttje K, Heinemeyer D, Uhl M, Schirle P, Benad H, Glaser M, Panzer W, Huettemann E, Stierwaldt R, Schappacher M, Müller E, Stadlmeyer W, Fantini M, Dummer B, Thörner M, Jost V, Loerbroks T, Glück T, Zimmermann R, Clement R, Hering R, Klinger T, Mehl J, Polozek H, Rothhammer A, Seidler R, Lorenz P, Lutze M, Euler M, Heintz M, Winkler M, Angstwurm M, Krohe K, Treu T, Steiner T, Locher S, Walz A, Zahn P, Brandt W, Marks M, Henning F, Janssens U, Luethgens M, Theelen W, Sydow M, Weber M, Meiser A, Deutschmann C, Buttner C, Jokiel M, Bozzetti C, Jürgen B, Fiedler F, Wresch K, Kremer A, Bleier H, Rueckert M, Ditter H, Peckelsen C, Friederich P, Weber K, Krueger W, Lowack R, Michalsen A, Ragaller M, Groeschel A, Friedrich T, Hoffmann U, Hinz M, Christel A, Ragaller M, Hartwig T, Vögeler S, Weiss M, Reiter K, Schwab T, Trieschmann U, Kindgen-milles D, Engel J, Sedemund-adib B, Lauterbach M, Max M, Volkert T, Waydhas C, Hien S, Briegel J, Guralnik V, Zoremba N, Riessen R, Müllges W, Nierhaus A, Strauss R, Utzolino S, Thul J, Abel P, Gründling M, Keßler W, Scheuren K, Lothar E, Kaisers U, Schmitt D, Schneider D, Vagts D, Rensing H, Schoch B, Kopp K, Gerlach H, Corea M, Uhrig A, Schroeder S, Jordan F, Huber T, Bittinger M, Sofianos E, Armaganidis A, Routsi C, Bitzani M, Chalkiadaki A, Michalopoulos A, Mouloudi E, Ioannidou E, Myrianthefs P, Koulenti D, Karampela I, Kyriazopoulos G, Mandragos K, Clouva-molyvdas P, Moraiti A, Pneumatikos I, Filos K, Zakynthinos E, Kotanidou A, Vakalos A, Cheng A, Buckley T, Gomersall C, Kiss K, Tamási P, Sarkany A, Csomos A, Zöllei É, Todi S, Udwadia F, Shah R, Amin P, Udwadia F, Samavedam S, Mathai A, Patil M, Jog S, Gurjar M, Vats M, Varma A, Gopal P, Kapadia F, Chawla R, Iyer S, Sahu S, Bakshi C, Ambike D, Govil D, Karipparambath V, Chacko J, Sathe P, Rungta N, Jani C, Bhome A, Prayag S, Ray S, Rajagopalan R, Divatia J, Da costa R, Shyam Sunder T, Wibowo P, Maskoen T, Sugiman T, Nowruzinia S, Lotfi A, Mahmoodpoor A, Donnelly M, Breen D, Ng S, Bates J, Sprung C, Lev A, Kishinevsky E, Cohen J, Sofer S, Vesconi S, Greco S, Borelli M, Cecilia P, Sapuppo M, Lazzero A, Mangani V, Petrucci N, Minerva M, De blasio E, Marzorati S, Rosi R, Giarratano A, Margarit O, Guberti A, Scolz S, Stelian E, Emmi V, Caspani M, Rosano A, Abbruzzese C, Colonna S, Ceriani R, De Blasi R, Panella L, Borrelli F, Lorella P, Ruatti H, Munch C, Sorbara C, Fiore G, Chieregato A, Conti V, Guadagnucci A, Pizzamiglio M, Locicero M, Marri I, Sicignano A, Conte V, Oggioni R, De Gasperi A, De Negri P, Santagostino G, Fumagalli R, Marino G, Castiglione G, Sforza D, Giuseppe N, Bassetti M, Ferraro F, Clementi S, Alessandro D, Cotogni P, Ranieri MV, Antonelli M, Martinelli L, Gianesello L, Gullo A, Morelli A, Biancofiore G, Della Rocca G, Hashimoto S, Onodera M, Kobayashi A, Shinozuka T, Imanaka H, Ikeda T, Yaguchi A, Misane I, Piebalga A, Moughaghab A, Pilvinis V, Vosylius S, Balciunas M, Kekstas G, Margaret H, Klop M, Grozdanovski K, Eftimova B, Wafa S, Lim C, Mat nor M, Tai L, Syed Mohd Tahir S, Idris N, Tan C, Borg M, Manzo E, Gutierrez Morales H, Miguel P, Villagomez A, Bassols A, Aguirre G, Cerón U, Lopez ramos J, Monjardín J, Bermudez Aceves E, Gonzalez Salazar F, Rodriguez Gonzalez D, Poblano-Morales M, Ramirez F, Cetina M, Navarro J, Villagomez Ortiz A, Sanchez V, Chavarria U, Fernandez-Ponce O, Serna secundino H, Leonardo O, Diego Manuel R, Mijangos J, Vazquez de Anda G, Martin E, Gutierrez P, López Islas I, Soberanes L, Ljubica P, Sbihi A, Ouahid B, Naoufel M, De Pont A, Rosseel P, Ten Cate J, Van Berkel G, Corsten S, Bakker J, Vogelaar J, Blom H, Kieft H, Kuiper M, Gille A, Pickkers P, Vet J, Ammann J, Den Boer S, Wesselink R, Speelberg B, Pham C, Rodgers M, Bergmans D, Groeneveld J, McArthur C, Parke R, Mehrtens J, Celi L, Freebairn R, Rankin N, Heffernan C, McHugh G, Beca J, Van Haren F, Barry B, Kalkoff M, Loevstad R, Klepstad P, Erno P, Junker A, Naqvi S, Javed I, Sinclair J, Rivera R, Chavez C, Donayre Taber Z, Quispe Sierra R, Muñoz J, Galvez Ruiz J, Fang Li J, Candiotti Herrera M, Arroyo A, Becerra R, Meza J, Mayorga M, Garba P, Kot J, Gaszynski T, Piechota M, Renata S, Müller P, Stepinska J, Jacek K, Cieniawa T, Mikstacki A, Tamowicz B, Bartkowska-Sniatkowska A, Karpel E, Kusza K, Smuszkiewicz P, Mikaszewska-Sokolewicz M, Goraj R, Kubler A, Bártolo A, Castelo-Branco Sousa M, Esteves F, Martins A, Oliveira T, Ponce P, Mourão L, Febra C, Carmo E, Lopes V, Póvoa P, Rezende A, Costa H, Moreira P, Pádua F, Leite A, Almeida E, Alves M, Sousa A, Telo L, Dias C, Paiva J, Ribeiro R, Amaro P, Carneiro A, Moreno R, Matos R, Afonso S, Bouw M, França C, Ibrahim A, Tabacaru R, Ionita V, Tulbure D, Filipescu D, Pascanu S, Grigoras I, Copotoiu S, Popov D, Lebedev E, Olga I, Yaroshetskiy A, Lugovkina T, Dmitry B, Malinin O, Lekmanov A, Abulmagd M, Arabi Y, Alhashemi J, Ali A, Maghrabi K, Debek A, Malik M, Jankovic R, Palibrk I, Maravic-stojkovic V, Malenkovic V, Surbatovic M, Bumbasirevic V, Lim N, Loh T, Tan H, Sekeresova H, Koutun J, Firment J, Malik P, Trenkler S, Muzlovic I, Kosec L, Ozek B, Kasnik D, Tomic V, Knafelj R, Svigelj V, Du Plessis H, Raine R, Bhagwanjee S, Richards G, Scribante J, Goosen J, De Jager J, Schleicher G, Rubio O, Mañez R, Burgueño Campiñez M, Alvarez M, Jorda R, Naveira-Abeigón E, Monedero P, Alemparte-Pardavila E, Garcia del Valle S, Perez Calvo C, Palomar M, Guerrero F, Caballero Zirena A, Arribas M, Bustamante Munguira E, Ruiz J, Iglesias L, Zavala E, Valencia M, Blesa Malpica A, Martinez-Sagasti F, Nieto M, Aguilar G, Martinon-Torres F, Lorente C, Insausti J, Vegas Pinto R, Santos I, Escriba A, Olaechea P, Muñoz E, Antón Caraballo E, Galdos-Anuncibay P, Lopez Camps V, Esteban-Reboll F, Estella A, Bocero L, Ibañez A, Pueyo L, María Jesús L, Iglesias L, Silva J, Garro P, Ramos-gómez L, Rovira A, Martin Delgado M, Monton Dito J, Garcia F, Navarro J, Latour-Perez J, Albaya A, Bustinza A, Sole-violán J, Ugarte Peña P, Yuste I, De Rojas Román J, Vallés J, Esteban E, Quintana Tort-Martorell E, Moreno M, López Ciudad V, Manzano Ramirez A, Sánchez-Olmedo J, Borges M, Amador Amerigo J, Guerrero F, Montejo González J, Sirvent J, Mesalles Sanjuan E, Barcenilla-Gaite F, Serrano N, Cerdá E, Lesmes Serrano A, Garcia-Fuentes C, Macias Pingarrón J, Espinosa E, Sanchez Garcia M, Felices F, de la Torre-Prados M, Maria Jesus H, Luis V, Jara R, Briones Lopez M, Posada P, Galvan B, Mariscal F, Rello J, Gil B, Sierra R, Rico-Feijoo J, Corcobado Márquez C, Izura J, González J, Soto Ibáñez J, Agabani H, Petersen P, Johansson L, Blomqvist H, Peterzén B, Wyon N, Lindström I, Paulsson A, Agvald-Ohman C, Petersson J, Friberg H, Einar V, Hammarskjöld F, Schindele M, Arvidsson S, Sellgren J, Hulting J, Häggqvist J, Rudenstam J, Lind D, Kokinsky E, Owall A, Jacobson S, Stiernstrom H, Nydahl A, Eggimann P, Stocker R, Loderer G, Loetscher R, Mehlig A, Heer K, Zender H, Cottini S, Pagnamenta A, Eich G, Felleiter P, Maggiorini M, Pugin J, Shu-Hui W, Hsieh K, Toomtong P, Khwannimit B, Kietdumrongwong P, Khaldi A, Messadi A, Labbene I, Frikha N, Atalan K, Ates C, Kahveci A, Fistikci H, Kaya A, Ozgencil E, Kizilkaya M, Bosnak M, Bodur H, Akan M, Guven M, Turkoglu M, Topeli A, Togal T, Uzel N, Akinci I, Cakar N, Tugrul S, Demirkiran O, Adanir T, Dogruer K, Turkmen A, Guven H, Ulger F, Kocak S, Nalapko Y, Nalapko Y, Rady S, Alsabbah A, Elahi N, Al rahma H, Rahman M, Kashef S, Cuthbertson B, Gunning K, Myint Y, Bewley J, Burnstein R, Haji-Michael P, Wrathall D, Folan L, Nesbitt I, Ratnaparkhi A, Pambakian S, Booth M, Watters M, Sherry T, Buehner U, Barrera Groba C, Bothma P, George N, Millo J, Hollos L, Mclellan S, Hunter J, Garrioch M, O'Keeffe N, Divekar N, Eggert S, Smith S, Vincent A, Withington P, Macmillan C, Webster R, Vuylsteke A, Appadu B, Barrera groba C, McQuillan P, Blunt M, Parekh N, William D, Jones C, Krige A, Schuster-Bruce M, Boyden J, Boulanger C, Swann D, Walker J, Wigmore T, Law R, Baldwin F, Muench C, Robinson S, Crerar-Gilbert A, Rhodes A, Mahambrey T, Cameron L, Thornton J, Stotz M, Russell M, Longmate A, Kitson R, Browne B, Thorniley A, Gonzalez I, Swart M, Singer M, Gautam N, Prasad V, Watson D, Szakmany T, Cardy J, Binning A, Loveland R, Gannon J, Martinelli G, Nightingale P, Howes J, Steingrub J, Ammons L, Fisher M, Gandhi N, Martin G, Deutschman C, Dean N, Michetti C, Belzberg H, Hutchinson K, Van der kloot T, Afessa B, Kaufman D, Iqbal J, Ost D, West M, Wunderink R, Afifi S, Stein S, Hagg D, Jimenez E, Blosser S, Chhangani S, Kleinpell R, Reich H, Fileds E, Willms D, Castellanos-Mateus P, Melnik L, Oud L, Chi E, Brown Y, Halfon R, Badr A, Restrepo M, Castellanos-Mateus P, Pohlman A, Branson R, Simpson S, Kett D, Jacobs T, Park P, Wahl W, Patricia C, Hammersley J, Papadimos T, Sawyer R, Freire A, Rodriguez W, Ryan A, Margolis B, Groth M, Escanda H, Baraibar J, Paciel D, Bagnulo H, Hitta F, Nadales P, Albornoz H, Salmen Z, Pacheco C, Bui T, Potie F, Nguyen Huu C.

Abstract

BACKGROUND:

Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis.

AIMS:

We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients.

METHODS:

We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation.

RESULTS:

The EPIC II database includes 13,796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05).

CONCLUSIONS:

Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.

KEYWORDS:

cirrhosis; infection; mortality; organ failure

PMID:
24606193
DOI:
10.1111/liv.12520
[Indexed for MEDLINE]

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