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Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis

OBJECTIVE: Patients with liver cirrhosis (LC) are at increased risk for bacterial infections. It is not fully understood how exposure to infections induces further development of hepatic encephalopathy (HE). This study estimated risks of infection associated with HE among patients with LC. METHODS:...

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Autores principales: Yuan, Lan-Ting, Chuah, Seng-Kee, Yang, Shih-Cheng, Liang, Chih-Ming, Wu, Cheng-Kun, Tai, Wei-Chen, Hung, Tsung-Hsing, Nguang, Seng-Howe, Wang, Jiunn-Wei, Tseng, Kuo-Lun, Ku, Ming-Kun, Hsu, Pin-I, Wu, Deng-Chyang, Hsu, Chien-Ning
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945008/
https://www.ncbi.nlm.nih.gov/pubmed/29746564
http://dx.doi.org/10.1371/journal.pone.0197127
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author Yuan, Lan-Ting
Chuah, Seng-Kee
Yang, Shih-Cheng
Liang, Chih-Ming
Wu, Cheng-Kun
Tai, Wei-Chen
Hung, Tsung-Hsing
Nguang, Seng-Howe
Wang, Jiunn-Wei
Tseng, Kuo-Lun
Ku, Ming-Kun
Hsu, Pin-I
Wu, Deng-Chyang
Hsu, Chien-Ning
author_facet Yuan, Lan-Ting
Chuah, Seng-Kee
Yang, Shih-Cheng
Liang, Chih-Ming
Wu, Cheng-Kun
Tai, Wei-Chen
Hung, Tsung-Hsing
Nguang, Seng-Howe
Wang, Jiunn-Wei
Tseng, Kuo-Lun
Ku, Ming-Kun
Hsu, Pin-I
Wu, Deng-Chyang
Hsu, Chien-Ning
author_sort Yuan, Lan-Ting
collection PubMed
description OBJECTIVE: Patients with liver cirrhosis (LC) are at increased risk for bacterial infections. It is not fully understood how exposure to infections induces further development of hepatic encephalopathy (HE). This study estimated risks of infection associated with HE among patients with LC. METHODS: A nested case-control study of 14,428 adult patients with LC was performed using the population-based Longitudinal Health Insurance Database 2000 in Taiwan. Cases were cirrhotic patients who developed HE during follow-up. Controls were matched to each case by age at LC diagnosis (±2 years), sex, Charlson Comorbid index score, year of LC, and follow-up time with a 1:1 ratio. A multivariate logistic regression model was used to determine and compare the odds of developing HE based on exposure to various risk factors, including site of infection, cirrhosis-related complications, Helicobacter pylori eradication therapy, and peptic ulcer bleeding. Patient survival was evaluated using the time-dependent Cox regression model. RESULTS: Cirrhotic patients with HE (n = 714) and without HE (n = 714) were matched to compare risks. Infections and more frequent yearly infections were significantly associated with increased risk of HE. Independent predictors of HE included spontaneous bacterial peritonitis (aOR, 5.13; 95% CI, 3.03–8.69), sepsis (aOR, 2.54; 95% CI, 1.82–-3.53), and biliary tract infection (aOR, 2.03; 95% CI, 1.2–3.46), controlling for confounders. CONCLUSION: Frequent infections are associated with increased risk of HE in cirrhotic patients. More frequent exposure to infection increases the risk of HE and mortality rates. Appropriate prevention of infection and the use of antibiotics for cirrhotic patients at risk for HE are needed.
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spelling pubmed-59450082018-05-25 Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis Yuan, Lan-Ting Chuah, Seng-Kee Yang, Shih-Cheng Liang, Chih-Ming Wu, Cheng-Kun Tai, Wei-Chen Hung, Tsung-Hsing Nguang, Seng-Howe Wang, Jiunn-Wei Tseng, Kuo-Lun Ku, Ming-Kun Hsu, Pin-I Wu, Deng-Chyang Hsu, Chien-Ning PLoS One Research Article OBJECTIVE: Patients with liver cirrhosis (LC) are at increased risk for bacterial infections. It is not fully understood how exposure to infections induces further development of hepatic encephalopathy (HE). This study estimated risks of infection associated with HE among patients with LC. METHODS: A nested case-control study of 14,428 adult patients with LC was performed using the population-based Longitudinal Health Insurance Database 2000 in Taiwan. Cases were cirrhotic patients who developed HE during follow-up. Controls were matched to each case by age at LC diagnosis (±2 years), sex, Charlson Comorbid index score, year of LC, and follow-up time with a 1:1 ratio. A multivariate logistic regression model was used to determine and compare the odds of developing HE based on exposure to various risk factors, including site of infection, cirrhosis-related complications, Helicobacter pylori eradication therapy, and peptic ulcer bleeding. Patient survival was evaluated using the time-dependent Cox regression model. RESULTS: Cirrhotic patients with HE (n = 714) and without HE (n = 714) were matched to compare risks. Infections and more frequent yearly infections were significantly associated with increased risk of HE. Independent predictors of HE included spontaneous bacterial peritonitis (aOR, 5.13; 95% CI, 3.03–8.69), sepsis (aOR, 2.54; 95% CI, 1.82–-3.53), and biliary tract infection (aOR, 2.03; 95% CI, 1.2–3.46), controlling for confounders. CONCLUSION: Frequent infections are associated with increased risk of HE in cirrhotic patients. More frequent exposure to infection increases the risk of HE and mortality rates. Appropriate prevention of infection and the use of antibiotics for cirrhotic patients at risk for HE are needed. Public Library of Science 2018-05-10 /pmc/articles/PMC5945008/ /pubmed/29746564 http://dx.doi.org/10.1371/journal.pone.0197127 Text en © 2018 Yuan et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Yuan, Lan-Ting
Chuah, Seng-Kee
Yang, Shih-Cheng
Liang, Chih-Ming
Wu, Cheng-Kun
Tai, Wei-Chen
Hung, Tsung-Hsing
Nguang, Seng-Howe
Wang, Jiunn-Wei
Tseng, Kuo-Lun
Ku, Ming-Kun
Hsu, Pin-I
Wu, Deng-Chyang
Hsu, Chien-Ning
Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis
title Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis
title_full Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis
title_fullStr Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis
title_full_unstemmed Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis
title_short Multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis
title_sort multiple bacterial infections increase the risk of hepatic encephalopathy in patients with cirrhosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945008/
https://www.ncbi.nlm.nih.gov/pubmed/29746564
http://dx.doi.org/10.1371/journal.pone.0197127
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