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Bacterial infection in cirrhosis, with and without hepatocellular carcinoma
H Yoshida1, T Hamada, S Inuzuka
1Second Department of Medicine, Kurume University School of Medicine, Japan.
Insights
Bacterial infections are equally common in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. Infection rates increase with cirrhosis severity, indicating cirrhosis, not HCC, drives susceptibility.
Area of Science:
- Hepatology
- Infectious Diseases
- Oncology
Background:
- Bacterial infection prevalence in liver cirrhosis is unknown.
- Hepatocellular carcinoma (HCC) primarily affects patients with liver cirrhosis.
- No prior studies have assessed bacterial infection incidence in HCC patients.
Purpose of the Study:
- To determine the prevalence of bacterial infection in patients with HCC.
- To compare bacterial infection rates in HCC patients versus cirrhosis patients without HCC.
Main Methods:
- Retrospective analysis of 1140 patients with hepatic cirrhosis and/or HCC.
- Data collection on bacterial infection incidence.
Main Results:
- Overall bacterial infection incidence was 15.4% in 740 HCC patients and 15.3% in 400 cirrhosis patients without HCC.
- Infection rates correlated with cirrhosis severity (Child-Pugh classification).
- Severe infections were noted in Child-Pugh class B and C patients.
Conclusions:
- HCC patients' susceptibility to bacterial infection is primarily due to underlying cirrhosis.
- Hepatocellular carcinoma itself does not appear to increase bacterial infection risk.
- Cirrhosis severity is a key factor in bacterial infection risk for both HCC and non-HCC patients.
Objective:
The extent and type of bacterial infection occurring with liver cirrhosis has remained unknown. Further, while hepatocellular carcinoma (HCC) is known to occur mainly in patients with liver cirrhosis, no report has yet investigated the incidence of bacterial infection in HCC. The purpose of the present study was to establish the prevalence of bacterial infection in patients with HCC.
Methods:
We have retrospectively investigated all 1140 patients with hepatic cirrhosis and/or HCC for any incidence of bacterial infection.
Results:
The incidence of bacterial infection was found to be 15.4%, in 740 patients with HCC. This was approximately equal to the incidence of bacterial infection in 400 patients with cirrhosis without HCC, which was found to be 15.3%. When the severity of cirrhosis was graded according to Child-Pugh classification, the incidences of bacterial infection in Child-Pugh class A, class B, and class C were 3.3%, 11.1%, and 31.2%, respectively, in cirrhosis, and 2.3%, 9.1% and 25.6% in HCC. The incidence of bacterial infection increased with the severity of cirrhosis and severe bacterial infections occurred in Child-Pugh class B and C patients.
Conclusion:
The data suggest that the susceptibility of HCC patients to bacterial infection is mainly related to the underlying cirrhosis and not to the HCC.