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Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study

Background: Patients with cirrhosis are susceptible to infections, especially by multidrug-resistant organisms (MDROs). There are limited data on the incidence of culture-positive infections and the validity of Sepsis 3-criteria in patients with cirrhosis admitted to the intensive care unit (ICU) in...

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Autores principales: Kulkarni, Anand, Rakam, Kalyan, Avadhanam, Mahathi, V.P, Yogita, Rachakonda, Chinmayee, Satyavadi, Anveshi, Zuberi, Asim A, Reddy, Santhosh, Iyengar, Sowmya, Gupta, Anand, Sharma, Mithun, Padaki, Nagaraja R, Rajender, Reddy, Duvvur, Nageshwar Reddy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10652166/
https://www.ncbi.nlm.nih.gov/pubmed/38022175
http://dx.doi.org/10.7759/cureus.47151
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author Kulkarni, Anand
Rakam, Kalyan
Avadhanam, Mahathi
V.P, Yogita
Rachakonda, Chinmayee
Satyavadi, Anveshi
Zuberi, Asim A
Reddy, Santhosh
Iyengar, Sowmya
Gupta, Anand
Sharma, Mithun
Padaki, Nagaraja R
Rajender, Reddy
Duvvur, Nageshwar Reddy
author_facet Kulkarni, Anand
Rakam, Kalyan
Avadhanam, Mahathi
V.P, Yogita
Rachakonda, Chinmayee
Satyavadi, Anveshi
Zuberi, Asim A
Reddy, Santhosh
Iyengar, Sowmya
Gupta, Anand
Sharma, Mithun
Padaki, Nagaraja R
Rajender, Reddy
Duvvur, Nageshwar Reddy
author_sort Kulkarni, Anand
collection PubMed
description Background: Patients with cirrhosis are susceptible to infections, especially by multidrug-resistant organisms (MDROs). There are limited data on the incidence of culture-positive infections and the validity of Sepsis 3-criteria in patients with cirrhosis admitted to the intensive care unit (ICU) in India, which we aimed to assess. Methods: In this prospective study, we included consecutive patients with cirrhosis admitted to the ICU between November 1, 2021, and April 30, 2022. The primary objective was to compare the outcomes of patients with microbiologically proven infections with those without proven infections. The secondary objective was to assess the predictors of infections and mortality and the impact of drug-resistant organisms. Results: A total of 298 patients (9.4% women) were included. The incidence of microbiologically proven infection was 34% (101/298; 95%CI=27.6-41.2). Most patients (61%) had healthcare-associated infections, Gram-negative organisms accounted for 75.3%, and bacteremia was the commonest site. Drug-resistant organisms accounted for 52.5% (53/101; 95%CI=39.3-68.7), of which 39.6% were multidrug-resistant (MDR) and 12.8% were extensively drug-resistant (XDR). Mortality was significantly higher in patients with proven infections than those without (61.4% vs. 44.2%; P=0.007). The sequential organ failure assessment (SOFA) score (OR=1.91; 95%CI=1.04-3.52; P<0.001) and presence of fever and/or positive quick SOFA (qSOFA; OR=1.91;1.04-3.52; P=0.03) were associated with an increased risk of infections. The SOFA score (OR=1.06;95%CI=1.002-1.12; P=0.04), MELD NA score (OR=1.08;95%CI=1.05-1.12; P<0.001), and presence of fever and/or positive qSOFA (OR=2.19; 95%CI=1.27-3.76; P=0.005) predicted mortality. Conclusions: One-third of the patients with cirrhosis admitted to the ICU had microbiologically proven infection, and the mortality rate in such patients was high. SOFA, qSOFA, and fever can predict microbiologically proven infections and mortality in patients with cirrhosis.
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spelling pubmed-106521662023-10-16 Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study Kulkarni, Anand Rakam, Kalyan Avadhanam, Mahathi V.P, Yogita Rachakonda, Chinmayee Satyavadi, Anveshi Zuberi, Asim A Reddy, Santhosh Iyengar, Sowmya Gupta, Anand Sharma, Mithun Padaki, Nagaraja R Rajender, Reddy Duvvur, Nageshwar Reddy Cureus Gastroenterology Background: Patients with cirrhosis are susceptible to infections, especially by multidrug-resistant organisms (MDROs). There are limited data on the incidence of culture-positive infections and the validity of Sepsis 3-criteria in patients with cirrhosis admitted to the intensive care unit (ICU) in India, which we aimed to assess. Methods: In this prospective study, we included consecutive patients with cirrhosis admitted to the ICU between November 1, 2021, and April 30, 2022. The primary objective was to compare the outcomes of patients with microbiologically proven infections with those without proven infections. The secondary objective was to assess the predictors of infections and mortality and the impact of drug-resistant organisms. Results: A total of 298 patients (9.4% women) were included. The incidence of microbiologically proven infection was 34% (101/298; 95%CI=27.6-41.2). Most patients (61%) had healthcare-associated infections, Gram-negative organisms accounted for 75.3%, and bacteremia was the commonest site. Drug-resistant organisms accounted for 52.5% (53/101; 95%CI=39.3-68.7), of which 39.6% were multidrug-resistant (MDR) and 12.8% were extensively drug-resistant (XDR). Mortality was significantly higher in patients with proven infections than those without (61.4% vs. 44.2%; P=0.007). The sequential organ failure assessment (SOFA) score (OR=1.91; 95%CI=1.04-3.52; P<0.001) and presence of fever and/or positive quick SOFA (qSOFA; OR=1.91;1.04-3.52; P=0.03) were associated with an increased risk of infections. The SOFA score (OR=1.06;95%CI=1.002-1.12; P=0.04), MELD NA score (OR=1.08;95%CI=1.05-1.12; P<0.001), and presence of fever and/or positive qSOFA (OR=2.19; 95%CI=1.27-3.76; P=0.005) predicted mortality. Conclusions: One-third of the patients with cirrhosis admitted to the ICU had microbiologically proven infection, and the mortality rate in such patients was high. SOFA, qSOFA, and fever can predict microbiologically proven infections and mortality in patients with cirrhosis. Cureus 2023-10-16 /pmc/articles/PMC10652166/ /pubmed/38022175 http://dx.doi.org/10.7759/cureus.47151 Text en Copyright © 2023, Kulkarni et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Gastroenterology
Kulkarni, Anand
Rakam, Kalyan
Avadhanam, Mahathi
V.P, Yogita
Rachakonda, Chinmayee
Satyavadi, Anveshi
Zuberi, Asim A
Reddy, Santhosh
Iyengar, Sowmya
Gupta, Anand
Sharma, Mithun
Padaki, Nagaraja R
Rajender, Reddy
Duvvur, Nageshwar Reddy
Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study
title Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study
title_full Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study
title_fullStr Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study
title_full_unstemmed Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study
title_short Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study
title_sort predictors and outcomes of infections in icu patients with cirrhosis: a single-center observational study
topic Gastroenterology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10652166/
https://www.ncbi.nlm.nih.gov/pubmed/38022175
http://dx.doi.org/10.7759/cureus.47151
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