Abstract
Bacterial infection is strongly associated with gastrointestinal bleeding in cirrhotic patients and seems to be related with the failure to control bleeding. The aims of this study were to assess the influence of infections on the failure to control bleeding and death in cirrhotic patients without antibiotic prophylaxis. Ninety-one consecutive bleeding cirrhotic patients were analyzed. Bleeding was managed using somatostatin with sclerotherapy for active bleeding. Screening for bacterial infection (analysis and culture of blood, urine, ascitic and other fluids, together with chest radiography) was made at time 0 and when clinical signs suggested infection. The cause of bleeding was variceal in 72 (79%) patients. Failure to control bleeding occurred in 24 (26%) patients, and 10 (11%) of the patients died. Compared with the group without infection, failure to control bleeding (65% vs 15%; P < 0.001) and mortality (40% vs 3%; P < 0.001), were observed more frequently in patients with infection. Multivariate analysis showed that bacterial infection (OR = 9.7; P < 0.001) and the presence of shock (OR = 3.5; P < 0.05) were independently associated with failure to control bleeding. Bacterial infection (OR = 12.6; P < 0.01), encephalopathy (OR = 6.9; P < 0.05), and shock (OR = 5.8; P < 0.05) were identified as predictive of death. In conclusion, in bleeding cirrhotic patients bacterial infection is associated with failure to control bleeding as well as mortality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Blaise M, Pateron D, Trinchet JC, Levacher S, Beaugrand M, Pourriat JL: Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology20:34–38,1994
Bleichner G, Boulanger R, Squara P, Sollet JP, Parent A: Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage.Br J Surg 73:724–726, 1986
Le Moine O, Adler M, Bourgeois N, Delhaye M, Devière J, Gelin M, Vandermeeren A, Van Gossum A, Vereerstraeten A, Vereerstraeten P, Cremer M: Factors related to early mortality in cirrhotic patients bleeding from varices and treated by urgent sclerotherapy.Gut33:1381–1385,1992
Bernard B, Cadranel JF, Valla D, Escolano S, Jaqrlier V, Opolon P: Prognostic significance of bacterial infection in bleeding cirrhotic patients: A prospective study.Gastroenterology 108:1828–1834,1995
Rimola A, Bory F, Terés J, Pérez-Ayuso R, Arroyo V, Rodés J: Oral nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage.Hepatology5:463–467,1985
Soriano G, Guarner C, Tomás A, Villanueva C, Torras X, González D, Sainz S, Anguera A, CussÓ X, Balanzo J, Vilardell F: Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrage.Gastroenterology103:1267–1272, 1992
Pauwels A, Mostefa-Kara N, Debenes B, Degoutte E, Levy VG:Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection. Hepatology24:802–806,1996
Hsieh WJ, Lin HC, Hwang SJ, Hou MC, Lee FY, Chang FY, lee SD: The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding.Am J Gastroenterol93:962–966,1998
Barnes PF, Arevalo C, Chan LS, Wong SF, Reynolds TB: A prospective evaluation of bacteremic patients with chronic liver disease.Hepatology8:1099–1103,1988
Caly WR, Strauss E: A prospective study of bacterial infections in patients with cirrhosis.J Hepatol18:353–358,1993
Goulis J, Armonis A, Patch D, Sabin C, Geenslade L, Burroughs AK:Bacterial infection is independently associated with failure to control bleeding in cirrhotic patients with gastrointestinal hemorrhage.Hepatology 27:1207–1212,1998
Bernard B, Grangé JD, Khac EN, Amiot X, Opolon P, Poynard T: Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis.Hepatology 29:1655–1661,1999
Ben-Ari Z, Cardin F, McCormick AP, Wannamethee G, Burroughs AK: A predictive model for failure to control bleeding during acute variceal haemorrhage.J Hepatol31:443–450, 1999
Baker J, Deitch E, Li M, Berg R, Specian R: Hemorrhagic shock promotes the systemic translocation of bacteria from the gut.J Trauma28:896,1988
Deitch E, Morrison J, Berg R, Specian R: Effect of hemorrhagic shock on bacterial translocation, intestinal morphology, and intestinal permeability in conventional and antibioticdecontaminated rats.Crit Care Med18:529–536,1990
Guarner C, Runyon BA: Macrophage function in cirrhosis and the risk of bacterial infection.Hepatology 22:367–369, 1995
Planas R, Quer JC, Boix J, Canet J, Armengol M, Cabre E, Pintanel T, Humbert P, Oller B, Broggi MA: A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding.Hepatology20:370–375,1994
Goulis J, Patch D, Burroughs AK: Bacterial infection in the pathogenesis of variceal bleeding.Lancet353:139–142,1999
Prindiville T, Miller M, Trudeau W: Prognostic indicators in acute variceal hemorrhage after treatment by sclerotherapy. Am J Gastroenterol82:655–659,1987
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vivas, S., Rodriguez, M., Palacio, M.A. et al. Presence of Bacterial Infection in Bleeding Cirrhotic Patients Is Independently Associated with Early Mortality and Failure to Control Bleeding. Dig Dis Sci 46, 2752–2757 (2001). https://doi.org/10.1023/A:1012739815892
Issue Date:
DOI: https://doi.org/10.1023/A:1012739815892