Incidence and Mortality of Community-Acquired Sepsis or Bacteraemia in Patients With Alcohol-Related Cirrhosis

Liver cirrhosis is associated with an increased risk of bacterial infections, but there is a lack of reliable population-based data to quantify this risk. We examined the incidence and predictors of community-acquired serious systemic infections.

This was a population-based study that included all patients in the Central Denmark Region diagnosed with alcohol-related cirrhosis (ALD cirrhosis) in 2013-2022. We computed the cumulative incidence of community-acquired serious systemic infections, encompassing sepsis and bacteraemia. We used Fine & Gray regression to investigate predictors of infection within the first year.

We included 2511 patients with ALD cirrhosis (69.3% males, median age 61 years, median MELD-NA score 13). Their cumulative risk of a first-time community-acquired serious systemic infection was 3.8% (95% CI: 3.1-4.6) after 1 year and 5.9% (95% CI: 5.0-6.9) after 3 years. The most frequent causative pathogens were Enterobacterales (38%), Staphylococci (25%) and Streptococci (22%). Increasing MELD-Na score at cirrhosis diagnosis was associated with an increased risk of serious systemic infection within the first year after diagnosis (subdistribution hazard ratio = 1.05, 95% CI: 1.02-1.08, per 1 point increase). The 30-day all-cause mortality was 30% (95% CI: 23-37) following hospitalization with a serious systemic infection.

This population-based study determined the risk and mortality of serious systemic infections in ALD cirrhosis. Our findings will be important for future studies of interventions to prevent infections.