Risk factors for the development of bacterial infections in hospitalized patients with cirrhosis

Bacterial infection is a frequent and severe complication of cirrhosis. Cirrhotic patients admitted for gastrointestinal bleeding are at high risk of such a complication and have been targeted in trials of antibiotic prophylaxis. However, it has not been shown that these patients are at a higher risk than cirrhotic patients hospitalized for other reasons. This prospective study was performed to assess the risk of bacterial infection in unselected hospitalized cirrhotic patients and to evaluate possible risk factors for this complication.

One hundred-forty hospitalized cirrhotic patients without clinical evidence of infection at the time of initial presentation were followed-up prospectively for manifestations of infection.

Twenty-eight (20%) patients developed an infection during their hospitalization. Infections without a specific site (39%) and spontaneous bacterial peritonitis (32%) were the most common diagnoses. Univariate analysis showed that patients who developed an infection were more likely to have a low serum albumin level, to be admitted for gastrointestinal bleeding, to stay in the intensive care unit, and to undergo therapeutic endoscopy. Logistic regression identified admission for gastrointestinal bleeding (odds ratio (OR) = 4.3, 95% confidence interval (CI) = 1.7-10.9) and a low serum albumin (OR = 1.3, 95% CI = 1.03-1.22) as the only two variables independently associated with the development of an infection.

The present study indicates that patients with severe cirrhosis who are admitted for gastrointestinal bleeding have a higher risk of developing a bacterial infection during their hospitalization than other cirrhotic patients.