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Sites and Causes of Infection in Patients with Sepsis-Associated Liver Dysfunction: A Population Study from the
Jinfeng Lin1, Chunfeng Gu2, Suyan Zhang1
1Critical Care Medicine, Nantong Third People's Hospital, Nantong University, Nantong, Jiangsu, China (mainland).
Abstract:
BACKGROUND Little is known about the relationship between the site of infection, type of pathogen, and the occurrence of sepsis-associated liver dysfunction (SALD). This population study aimed to identify the sites and types of infection in SALD patients. MATERIAL AND METHODS We conducted a retrospective observational study using the Medical Information Mart for Intensive Care III. Patients with sepsis were divided into a SALD group and a control group. We evaluated the effect of the location of culture-positive specimens and the distribution of pathogens on the occurrence of SALD and then compared the clinical outcomes. RESULTS A total of 14 596 admissions were included, and the incidence of SALD was 11.96%. Positive bile culture (odds ratio [OR] 7.450, P<0.001), peritoneal fluid culture (OR 3.616, P<0.001), and blood culture (OR 1.957, P<0.001) were correlated with the occurrence of SALD. Infection with Enterococcus faecium (OR 3.065, P<0.001), Bacteroides fragilis (OR 2.061, P<0.001), Klebsiella oxytoca (OR 2.066, P<0.001), Enterobacter aerogenes (OR 1.92, P=0.001), and Aspergillus fumigatus (OR 2.144, P=0.001) were correlated with the occurrence of SALD. The Intensive Care Unit mortality and hospital mortality were higher in the SALD group than in the control group (24.7% vs 9.0%, P<0.001; 34.2% vs 13.8%, P<0.001, respectively). CONCLUSIONS SALD should be considered for patients with sepsis whose infection site is the biliary system, abdominal cavity, or blood and the pathogen is Enterococcus faecium, B. fragilis, K. oxytoca, Enterobacter aerogenes, or A. fumigatus. When SALD occurs in patients with sepsis, the above infection sites and pathogens should be considered first.
Insights
Sepsis-associated liver dysfunction (SALD) is linked to specific infection sites like the biliary system and pathogens including Enterococcus faecium. Identifying these factors is crucial for patient outcomes.
Area of Science:
- Critical Care Medicine
- Hepatology
- Infectious Diseases
Background:
- The relationship between infection site, pathogen type, and sepsis-associated liver dysfunction (SALD) is not well understood.
- SALD is a significant complication in sepsis patients, impacting outcomes.
Purpose of the Study:
- To identify specific infection sites and pathogen types associated with the occurrence of SALD.
- To compare clinical outcomes between patients with and without SALD.
Main Methods:
- Retrospective observational study using the Medical Information Mart for Intensive Care III (MIMIC-III) database.
- Patients with sepsis were categorized into SALD and control groups.
- Analysis of culture-positive specimen locations and pathogen distribution in relation to SALD development.
Main Results:
- The incidence of SALD was 11.96% in 14,596 admissions.
- Positive bile, peritoneal fluid, and blood cultures were significantly correlated with SALD.
- Infections with Enterococcus faecium, Bacteroides fragilis, Klebsiella oxytoca, Enterobacter aerogenes, and Aspergillus fumigatus were associated with SALD.
- SALD group exhibited higher ICU and hospital mortality rates compared to the control group.
Conclusions:
- SALD should be suspected in sepsis patients with infections originating from the biliary system, abdominal cavity, or bloodstream.
- Specific pathogens like Enterococcus faecium, Bacteroides fragilis, Klebsiella oxytoca, Enterobacter aerogenes, and Aspergillus fumigatus are key indicators for SALD.
- Prompt consideration of these infection sites and pathogens can aid in the early diagnosis and management of SALD in sepsis patients.
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