Objective To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis.
Design This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child–Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework.
Results 1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control.
Conclusion BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.
- HEPATITIS B
- HEPATITIS C
- BACTERIAL INFECTION
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Collaborators Microcir group: Marie Kempf (CHU Angers, laboratoire de Bactériologie, Angers), Fréderic Bert (APHP Hôpital Beaujon, Service de Microbiologie, Clichy), Alexandra Doloy (APHP, Hôpital Cochin, Laboratoire de Bactériologie, Paris), Isabelle Poilane (AP-HP, Hôpital Jean Verdier, Service de Microbiologie, Bondy), Olivia Peuchant (CHU Haut Lévêque, Laboratoire de Bactériologie, Bordeaux), Etienne Carbonnelle (AP-HP Hôpital Avicenne, Laboratoire de Bactériologie-Virologie Hygiène, Bobigny), Bertrand Picard (AP-HP Hôpital Avicenne, Laboratoire de Bactériologie-Virologie Hygiène, Bobigny), Christophe Burucoa (CHU Poitiers, Laboratoire de Bactériologie, Poitiers), Vincent Cattoir (CHU Caen, Service de Microbiologie, Caen), Dominique Decré (AP-HP Hôpital Saint Antoine, Paris), Nicolas Degand (CHU Nice, Laboratoire de Bactériologie, Nice), Laurent Dortet (AP-HP Hôpital Bicêtre, Laboratoire de Bactériologie Le Kremlin Bicêtre), Samer Kayal (CHU Pontchaillou, Service de Bactériologie et Hygiène Hospitalière, Rennes), Véronique Vernet-Garnier (CHU Robert Debré, Laboratoire de Bactériologie, Reims), Alain Lozniewski (CHU Nancy, Laboratoire de Bactériologie, Nancy), Edouard Tuaillon (CHU-Hôpital Saint Eloi, Laboratoire de Bactériologie, Montpellier), Sophie Vimont (APHP, Hôpital Tenon, Laboratoire de Bactériologie, Paris), Emilie Bessède (CHU Pellegrin, Laboratoire de Bactériologie, Bordeaux), Isabelle Patry (CHU Jean Minjoz, Laboratoire de Bactériologie, Besançon), Nadine Lemaitre (CHRU Lille, Laboratoire de Bactériologie, Lille) and Christine Pachetii (CH Aix, Laboratoire de Diagnostic des Maladies Infectieuses, Aix en Provence).
Contributors PN, J-CT, ML, VB and FR-T had full access to all data in the study and take responsibility for the integrity of data and the accuracy of data analysis. Study concept and design: PN, J-CT, VB and FR-T. Acquisition of data: PN, VB, ML, RL, NT, PM, DG, SP, D, VDL, DO, FZ, DR, AT, J-PB, J-PZ, OG, PC, J-MP, LA, MB, PM, J-FB, AA, LS, AM, J-DG, Buffet, YB, CW, TD, YB, CP, CS, CC, DC, BB-C, SH, VDM, J-CT and FR-T. Analysis and interpretation of data: PN, VB, RL, ML, J-CT, RM and FR-T. Drafting of the manuscript: PN, VB, RL, ML and FR-T. Critical revision of the manuscript for important intellectual content: PN, VB, RL, ML, PM, DG, SP, DL, VDL, DO, FZ, DR, AT, J-PB, J-PZ, OG, PC, J-MP, LA, MB, PM, J-FB, AA, LS, AM, J-DG, Buffet, YB, CW, TD, YB, CP, CS, CC, DC, BB-C, SH, VDM, RM and FR-T. Statistical analysis: RL and FR-T. Funding obtained: J-CT. Administrative, technical and material support: PN, VB, RL, NT, J-CT and FR-T. Study supervision: PN, VB, RL, ML, J-CT and FR-T.
Funding The promoter of the study was the ANRS (France REcherche Nord and sud Sida-HIV Hépatites-FRENSH), with the cohort funded by the same institution.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Ethics approval The study protocol was in conformity with ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Institutional review board (Comité de Protection des Personnes, Aulnay-sous-Bois, France).