Risk factors for the outcome of cirrhotic patients with soft tissue infections

The aims of this study were to identify risk factors that influence outcomes of cirrhotic patients with soft tissue infections and to describe specific management for such patients.

Soft tissue infections account for 11% of infections overall in cirrhotic patients and the severe form of necrotizing infection carries a high mortality rate. It is essential that clinicians make an early diagnosis and start appropriate treatment to improve outcomes of cirrhotic patients with soft tissue infections.

Cirrhotic patients who had been admitted to our hospital with the diagnosis of soft tissue infection from June 1, 2003 to June 1, 2005 were included in this retrospective study. Clinical manifestations, laboratory data, and microbiologic results were recorded and compared between survivor and nonsurvivor groups.

There was a total of 118 episodes of admission for soft tissue infection with 26 episodes resulting in mortality and 92 in survival. The following clinical parameters showed significant differences between the 2 groups: Child-Pugh grade C, pain, altered consciousness, emergence of hemorrhagic bullae, and local injury. The following laboratory data showed significant differences between the 2 groups: appearance of band form, serum creatinine, serum albumin below 2.5 g/dL, serum bilirubin above 3 mg/dL, and prothrombin time prolongation greater than 5 seconds. Gram-negative bacterial infection was predominant in the nonsurvivor group and was statistically significant. Multivariate analysis showed that the emergence of hemorrhagic bullae and Child-Pugh grade C were independent predictive factors for outcome.

When treating soft tissue infection in cirrhotic patients, especially in those with Child-Pugh C liver function or emergence of hemorrhagic bullae, it is essential to start surgical evaluation and specific broad-spectrum antibiotics early to reduce the high mortality associated with this disease.