Aim: This study aims to investigate the morbidity, mortality, and health care utilization of infection in patients with cirrhosis, with the hope of making clinical recommendations.
Background: The pathophysiology of liver cirrhosis makes patients susceptible to a variety of complications including infection. It contributes to a staggering rate of death and places a tremendous financial burden on the health care system.
Methods: The pathophysiology of liver cirrhosis makes patients susceptible to a variety of complications including infection. It contributes to a staggering rate of death and places a tremendous financial burden on the health care system.
Results: In this cross-sectional study, we queried the National Inpatient Sample (NIS) database for patients discharged from United States (US) hospitals with International classification of diseases (ICD) diagnostic codes consistent with liver cirrhosis, between January 2011 and December 2014. The patients were classified based upon the presence or absence of an infection, as well as their demographics and comorbidities. The data was then analyzed using the IBM SPSS version 25 statistical software.
Conclusion: From 2011 to 2014, 660,727 cirrhotic patients were identified. Of these, 20.6% were found to have an infection. The mortality rate during hospitalization was 4.7% of all cirrhotic patients. The hospital length of stay was significantly longer for the study group than the control group (8.22 days versus 5.11 days) (P <0.0001). Similarly, the mean hospital cost was higher in the study group compared to the control group ($74,729.53 ± $125,963.75 vs. $46,413.32 ± $71,936.50 P< 0.0001).
Keywords: Liver Cirrhosis, infection, morbidity, mortality, hospital costs.
(Please cite as: Saleem S, Katragadda R, Weissman S, Bleibel W. Comparison of ISG15, IL28B and USP18 mRNA levels in peripheral blood mononuclear cells of chronic hepatitis B virus infected patients and healthy individuals Morbidity and mortality of infections in the cirrhotic patients: a US population-based study. Gastroenterol Hepatol Bed Bench 2019;12(3):233-238).
Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. J Am Med Assoc 2013;310:591–608.
Arvaniti V, D’Amico G, Fede G, Manousou P, Tsochatzis E, Pleguezuelo M, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterol 2010;139:1246–56.
Bunchorntavakul C, Chavalitdhamrong D. Bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. World J Hepatol 2012;4:158–68.
Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatol 2002;35:140–8.
Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993;18:353–8.
Strauss E. The impact of bacterial infections on survival of patients with decompensated cirrhosis. Ann Hepatol 2014;13:7–19.
Rubin JB, Sundaram V, Lai JC. Gender Differences Among Patients Hospitalized With Cirrhosis in the United States. J Clin Gastroenterol 2019.
Bajaj JS, O JG, Rajender Reddy K, Wong F, Olson JC, Subramanian RM, et al. Second Infections Independently Increase Mortality in Hospitalized Cirrhotic Patients: The NACSELD Experience. Hepatol 2012;56:2328–35.
Bajaj JS, O’Leary JG, Reddy KR, Wong F, Biggins SW, Patton H, et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatol 2014;60:250–6.
Baijal R, Amarapurkar D, Praveen Kumar HR, Kulkarni S, Shah N, Doshi S, et al. A multicenter prospective study of infections related morbidity and mortality in cirrhosis of liver. Indian J Gastroenterol 2014;33:336–42.
Cai J, Zhang M, Han T, Jiang HQ. Characteristics of infection and its impact on short-term outcome in patients with acute-on-chronic liver failure. Med 2017;96:e8057.
Sargenti K, Prytz H, Nilsson E, Kalaitzakis E. Predictors of mortality among patients with compensated and decompensated liver cirrhosis: the role of bacterial infections and infection-related acute-on-chronic liver failure. Scand J Gastroenterol 2015;50:875–83.
Garcia Garcia de Paredes A, Tellez L, Rodriguez-Gandia MA, Martinez J, Rodriguez de Santiago E, Aguilera Castro L, et al. Incidence, predictive factors and impacts of acute kidney injury in cirrhotic patients hospitalized for cellulitis. Liver Int 2018;38:285–94.
Weissenborn K. Minimal/Covert Hepatic Encephalopathy - Impact of Comorbid Conditions. J Clin Exp Hepatol 2019;9:109–11.
Ascione T, Di Flumeri G, Boccia G, De Caro F. Infections in patients affected by liver cirrhosis: An update. Infez Med 2017;25:91–7.
Kelly EM, James PD, Murthy S, Antonova L, Wong F, Shaw-Stiffel T, et al. Healthcare Utilization and Costs for Patients With End-stage Liver Disease are Significantly Higher at the End of Life Compared to Those of Other Decedents. Clin Gastroenterol Hepatol 2019;S1542-3565:30147-8.
Lawson-Ananissoh LM, Bouglouga O, Bagny A, El-Hadji Yakoubou R, Kaaga L, Redah D. Digestive diseases in elderly and factors associated with length of stay in the hepatology and gastroenterology unit of the campus teaching hospital of lome (Togo). Arq Gastroenterol 2018;55:369–74.
Jamil K, Huang X, Lovelace B, Pham AT, Lodaya K, Wan G. The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records. J Med Econ 2019;6:1–9.