Role of Portal Hypertension in Prediction of Bacterial Infection in Decompensated Cirrhosis

Abstract

Background: Bacterial infection in cirrhotic patients is a fatal complication. The high incidence of bacterial infections in those patients may be related to several alterations in the defensive mechanisms against infections and increased intestinal permeability with bacterial translocation. Aim: To evaluate the role of portal hypertension (PH) in predicting the occurrence of bacterial infections in decompensated cirrhosis. Patients and Methods: In this retrospective cohort study, 99 patients—56 males and 43 females, with decompensated liver cirrhosis were included. Diagnosis of liver cirrhosis was based on clinical, laboratory and ultrasonographic examinations. Patients were classified according to the presence of bacterial infection into patients with infection—Group 1, and those without infection—Group 2. Laboratory, abdominal US and upper endoscopic data for all patients were collected. Logistic regression analysis was done to detect the independent factors for prediction of bacterial infection. Results: The mean age of patients was 50.5 ± 14.2 years. Bacterial infection was found in 41 patients (41.4%) and no infection in 58 patients (58.6%). Infected patients showed statistically significant higher values in the level of bilirubin, PT and Child-Pugh score (P value = 0.000) and lower values in the level of albumin, total serum protein and PC than those without infection (P value = 0.006, 0.000 and 0.000 respectively). Portal vein diameter (PVD) and splenic diameter (SD) showed statistically significant higher values in infected patients than in those without infection (P value = 0.028 and 0.000 respectively), also infection was more significantly prevalent in patients with varices than those without varices (P value = 0.000). The independent predictors for bacterial infection were: the age, total serum bilirubin, serum albumin, PT, PC, child score, PVD, SD and the presence of varices. Conclusion: Presence of varices (as a complication of PH) is an independent risk factor for the development of bacterial infection in decompensated cirrhotic patients and reduction of PH by any way could decrease this fatal complication.

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Mahmoud, H. and El-Din S. Bazeed, S. (2014) Role of Portal Hypertension in Prediction of Bacterial Infection in Decompensated Cirrhosis. Open Journal of Gastroenterology, 4, 97-104. doi: 10.4236/ojgas.2014.43016.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Yoshida, H., Hamada, T., Inuzuka, S., et al. (1993) Bacterial Infection in Cirrhosis, with and without Hepatocellular Carcinoma. American Journal of Gastroenterology, 88, 2067-2071.
[2] Caly, W.R. and Strauss, E. (1993) A Prospective Study of Bacterial Infections in Patients with Cirrhosis. Journal of Hepatology, 18, 353-358.
http://dx.doi.org/10.1016/S0168-8278(05)80280-6
[3] Garcia-Tsao, G. (2004) Bacterial Infections in Cirrhosis. Canadian Journal of Gastroenterology, 18, 405-406.
[4] Borzio, M., Salerno, F., Piantoni, L., et al. (2001) Bacterial Infection in Patients with Advanced Cirrhosis: A Multicentre Prospective Study. Digestive and Liver Disease, 33, 41-48.
http://dx.doi.org/10.1016/S1590-8658(01)80134-1
[5] Bleichner, G., Boulanger, R., Squara, P., et al. (1986) Frequency of Infections in Cirrhotic Patients Presenting with Acute Gastrointestinal Hemorrhage. British Journal of Surgery, 73, 724-726.
http://dx.doi.org/10.1002/bjs.1800730916
[6] Bernard, B., Cadranel, J.F., Valla, D., et al. (1995) Prognostic Significance of Bacterial Infection in Bleeding Cirrhotic Patients: A Prospective Study. Gastroenterology, 108, 1828-1834.
http://dx.doi.org/10.1016/0016-5085(95)90146-9
[7] Goulis, J., Armonis, A., Patch, D., et al. (1998) Bacterial Infection Is Independently Associated with Failure to Control Bleeding in Cirrhotic Patients with Gastrointestinal Hemorrhage. Hepatology, 27, 1207-1212.
http://dx.doi.org/10.1002/hep.510270504
[8] Vivas, S., Rodriguez, M., Palacio, M.A., et al. (2001) Presence of Bacterial Infection in Bleeding Cirrhotic Patients Is Independently Associated with Early Mortality and Failure to Control Bleeding. Digestive Diseased Sciences, 46, 2752-2757.
http://dx.doi.org/10.1023/A:1012739815892
[9] Soares-Weiser, K., Brezis, M., Tur-Kaspa, R. and Leibovici, L. (2002) Antibiotic Prophylaxis for Cirrhotic Patients with Gastrointestinal Bleeding. Cochrane Database of Systematic Reviews, 2, CD002907.
[10] Fernandez, J., Navasa, M., Gomez, J., et al. (2002) Bacterial Infections in Cirrhosis: Epidemiological Changes with Invasive Procedures and Norfloxacin Prophylaxis. Hepatology, 35, 140-148.
http://dx.doi.org/10.1053/jhep.2002.30082
[11] Campillo, B., Richardet, J.P., Kheo, T. and Dupeyron, C. (2002) Nosocomial Spontaneous Bacterial Peritonitis and Bacteremia in Cirrhotic Patients: Impact of Isolate Type on Prognosis and Characteristics of Infection. Clinical Infectious Diseases, 35, 1-10.
http://dx.doi.org/10.1086/340617
[12] Campillo, B., Dupeyron, C., Richardet, J.P., et al. (1998) Epidemiology of Severe Hospital-Acquired Infections in Patients with Liver Cirrhosis: Effect of Long-Term Administration of Norfloxacin. Clinical Infectious Diseases, 26, 1066-1070.
http://dx.doi.org/10.1086/520273
[13] Merli, M., Lucidi, C., Giannelli, V., Giusto, M., Riggio, O., Falcone, M., et al. (2010) Cirrhotic Patients Are at Risk for HCA Bacterial Infections. Clinical Gastroenterology and Hepatology, 8, 979-985.
http://dx.doi.org/10.1016/j.cgh.2010.06.024
[14] Wiest, R. and Rath, H.C. (2003) Gastrointestinal Disorders of the Critically Ill. Bacterial Translocation in the Gut. Best Practice and Research Clinical Gastroenterology, 17, 397-425.
http://dx.doi.org/10.1016/S1521-6918(03)00024-6
[15] Garcia-Tsao, G. (1992) Spontaneous Bacterial Peritonitis. Gastroenterology Clinics of North America, 21, 257-275.
[16] Beppu, K., Inokuchi, K., Koyanagi, N., et al. (1981) Prediction of Variceal Haemorrhage by Oesophageal Endoscopy. Gastrointestinal Endoscopy, 27, 213-218.
http://dx.doi.org/10.1016/S0016-5107(81)73224-3
[17] Mc Cormack, T.T., Sims, J., Eyre-Brook, I., et al. (1985) Gastric Lesions in Portal Hypertension: Inflammatory Gastritis or Congestive Gastropathy? Gut, 26, 1226-1229.
http://dx.doi.org/10.1136/gut.26.11.1226
[18] Garcia-Tsao, G., Albillos, A., Barden, G. and Brian West, A. (1993) Bacterial Translocation in Acute and Chronic Portal Hypertension. Hepatology, 17, 1081-1085.
http://dx.doi.org/10.1002/hep.1840170622
[19] Rimola, A. and Navasa, M. (1999) Infections in Liver Disease. In: Bircherm, J., Benhamou, J.P., McIntyre, N., Rizzetto, M. and Rodes, J., Eds., Oxford Textbook of Clinical Hepatology, 2nd Edition, 1861-1874.
[20] Viggiano, T.R. and Gostout, C.J. (1992) Portal Hypertensive Intestinal Vasculopathy: A Review of the Clinical, Endoscopic, and Histopathologic Features. American Journal of Gastroenterology, 87, 944-954.
[21] Stanley, A.J., Gilmour, H.M., Ghosh, S., Ferguson, A. and McGilchrist, A.J. (1996) Transjugular Intrahepatic Portosystemic Shunt as a Treatment for Protein-Losing Enteropathy Caused by Portal Hypertension. Gastroenterology, 111, 1679-1682.
http://dx.doi.org/10.1016/S0016-5085(96)70033-1
[22] Chesta, J. and Deflippi, C. (1993) Abnormalities in Proximal Small Bowel Motility in Patients with Cirrhosis. Hepatology, 17, 828-832.
[23] Shindo, K., Machida, M., Miyakawa, K. and Fukumura, M. (1993) A Syndrome of Cirrhosis, Achlorhydria, Small Intestinal Bacterial Overgrowth, and Fat Malabsorption. American Journal of Gastroenterology, 88, 2084-2091.
[24] Cirera, L., Bauer, T., Navasa, M., Vila, J., Grande, L., Taura, P., Fuster, J., Garcia-Valdecasas, J., et al. (2001) Bacterial Translocation of Enteric Organisms in Patients with Cirrhosis. Journal of Hepatology, 34, 32-37.
http://dx.doi.org/10.1016/S0168-8278(00)00013-1
[25] Giannelli, V., Lattanzi, B., Thalheimer, U. and Merli, M. (2014) Beta-Blockers in Liver Cirrhosis. Annals of Gastroenterology, 27, 20-26.

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