B0506 - Infections in Patients With Cirrhosis Have a Changing Profile Over Time and Are Linked to a Higher Risk of Death Compared to Patients Without Cirrhosis

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Dan Park, MD

Virginia Commonwealth University Health System
Richmond, VA

Dan Park, MD, Kevin Houston, MD, Neerav Dharia, MD, Nikki Duong, MD, Jasmohan Bajaj, MD
Virginia Commonwealth University Health System, Richmond, VA

Introduction: Intensive care outcomes in patients with cirrhosis are relatively poor. The comparison between outcomes, especially related to infections, remains unclear in those with and without cirrhosis. With the emergence of resistant and fungal organisms, the changes in infection profiles over time are important to analyze. The aim of this study is to determine the impact of cirrhosis and infections on inpatient death over time in a qSOFA-matched cohort of patients with and without cirrhosis.

Methods: Inpatients admitted to ICUs throughout 2015-2021 were analyzed. Patients with cirrhosis were matched 1:1 by age, gender, and admission qSOFA to patients without; COVID-positive patients were excluded. Admission demographics, labs, the reasons for ICU transfer, infections, and inpatient death or hospice referral were obtained for each patient. Comparisons were made between patients with and without cirrhosis and those who died/referred to hospice versus not. Logistic regression for death/hospice was performed. In patients with cirrhosis, the culture results were compared over the years.

Results: 1669 patients; 833 cirrhosis and 836 non-cirrhosis patients were included. Patients with cirrhosis had higher rates of infection, positive culture, abdominal infection, and bacteremia. They also had higher gram-positive and fungal infections with a higher rate of VRE. They showed a greater organ failure load, death, and hospice referral compared to patients without cirrhosis.

Logistic regression showed that cirrhosis (OR 4.0, p< 0.0001), admission qSOFA (1.60, p< 0.0001), WBC (1.02, p=0.003), reasons for ICU (altered mental status 1.69, hypotension 1.79, renal support 2.77, respiratory failure 1.79, CVA 1.96, all p< 0.0001) with Infection (1.77, p< 0.0001, >1 microbe isolated 1.86, p=0.05) were risk factors for death/hospice.

The infection trend in the cirrhosis group showed a significant decrease in positive cultures and gram-negative infections and an increase in fungal and gram-positive infections over time.

Discussion: Despite matching for demographics and qSOFA, patients with cirrhosis had higher risks of death and organ failures. They were more likely to develop gram-positive and fungal infections with multiple organisms and VRE. Time trends in cirrhosis showed lower rates of positive cultures and gram-negative infections and an increase in fungal and gram-positive infections over time, which should encourage re-evaluation of diagnostic and prophylactic strategies in cirrhosis-related infections.

Figure: Image 1. Infection Profile Over Time in Patients With Cirrhosis

	Cirrhosis Vs No-Cirrhosis			Death or Hospice
	No Cirrhosis (n=836)	Cirrhosis (n=833)	P value	No (n=1213)	Yes (n=456)	P value
Age	57.0±12.1	57.0±12.1	0.98	56.9±12.2	57.5±11.7	0.32
Male Gender	386 (46.2%)	379 (45.5%)	0.78	538 (44.4%)	227 (49.8%)	0.05
Race (W/AA/As/Oth/U)	359 (42.9%)/414 (49.5%)/12 (1.4%)/51 (6.1%)	490 (58.8%)/253 (30.4%)/6 (0.7%)/84 (10.1%)	< 0.0001	597 (49.2%)/521 (43.0%)/13 (1.1%)/82 (6.8%)	252 (55.3%)/146 (32.0%)/5 (1.1%)/53 (11.6%)	< 0.0001
Latinx Ethnicity	16 (1.9%)	20 (2.4%)	0.50	25 (2.1%)	11 (2.4%)	0.66
QSOFA	2.47±0.69	2.47±0.69	0.93	2.41±0.73	2.63±0.56	< 0.0001
WBC	12.3±9.5	11.6±7.8	0.11	11.3±8.5	13.8±9.0	< 0.0001
Bilirubin	1.06±2.49	7.23±9.92	< 0.0001	2.56±5.29	8.30±11.30	< 0.0001
MELD-Na	13.9±7.5	25.4±9.9	< 0.0001	16.8±9.2	27.1±10.2	< 0.0001
Reason for ICU
Altered mental status	383 (45.8%)	395 (47.4%)	0.51	515 (42.5%)	263 (57.7%)	< 0.0001
Infection	293 (35.0%)	411 (49.3%)	< 0.0001	427 (35.2%)	277 (60.7%)	< 0.0001
CVA	116 (13.9%)	45 (5.4%)	< 0.0001	130 (10.7%)	31 (6.8%)	0.01
Hypotension	273 (32.7%)	454 (54.5%)	< 0.0001	450 (37.1%)	277 (60.7%)	< 0.0001
Renal support	52 (6.2%)	167 (20.0%)	< 0.0001	94 (7.7%)	125 (27.4%)	< 0.0001
Respiratory failure	474 (56.7%)	399 (47.9%)	< 0.0001	593 (48.9%)	280 (61.4%)	< 0.0001
Post-procedure	129 (15.4%)	98 (11.8%)	0.03	199 (16.4%)	28 (6.1%)	< 0.0001
Type of infection
Nosocomial?	25 (3.0%)	23 (2.8%)	0.78	27 (2.2%)	21 (4.6%)	0.01
Second infection	21 (2.5%)	26 (3.1%)	0.45	36 (3.0%)	11 (2.4%)	0.54
UTI	64 (7.7%)	71 (8.5%)	0.52	84 (6.9%)	51(11.2%)	0.006
Abdominal	24 (2.9%)	102 (12.2%)	< 0.0001	68 (5.6%)	58 (12.7%)	< 0.0001
Bacteremia	66 (7.9%)	104 (12.5%)	0.002	93 (7.7%)	78 (17.1%)	< 0.0001
Respiratory	143 (17.1%)	163 (19.6%)	0.19	193 (15.9%)	113 (24.8%)	< 0.0001
Skin/soft tissue	22 (2.6%)	23 (2.8%)	0.87	36 (3.0%)	10 (2.2%)	0.38
Organism details
Positive culture?	169 (20.2%)	225 (27.0%)	0.001	242 (20.0%)	152 (33.3%)	< 0.0001
Gram positive	82 (9.8%)	116 (13.9%)	< 0.0001	120 (9.9%)	78 (17.1%)	< 0.0001
Gram negative	63 (7.5%)	82 (9.8%)	0.09	85 (7.0%)	60 (13.2%)	< 0.0001
Fungus	10 (1.2%)	33 (4.0%)	< 0.0001	21 (1.7%)	22 (4.8%)	0.001
>1 organism	16 (1.9%)	25 (3.0%)	0.15	21 (1.7%)	20 (4.4%)	0.003
VRE	3 (0.4%)	16 (1.9%)	< 0.0001	7 (0.6%)	10 (2.2%)	0.006
MRSA	21 (2.5%)	14 (1.7%)	0.23	20 (1.6%)	15 (3.3%)	0.05
Fluoro res	12 (1.4%)	9 (1.1%)	0.52	16 (1.3%)	5 (1.1%)	0.71
Outcome
LOS	6.42±7.63	6.48±6.83	0.86	6.18±6.37	7.17±9.12	0.03
Renal failure	44 (5.3%)	163 (19.6%)	< 0.0001	90 (7.4%)	117 (25.7%)	< 0.0001
Brain failure	179 (21.4%)	237 (28.5%)	0.001	254 (20.9%)	12 (2.6%)	< 0.0001
Shock	174 (20.8%)	310 (37.2%)	< 0.0001	257 (21.2%)	227 (49.8%)	< 0.0001
Ventilation	331 (39.6%)	334 (40.1%)	0.83	435 (35.9%)	230 (50.4%)	< 0.0001
Coagulation failure	133 (15.9%)	545 (65.4%)	< 0.0001	374 (30.8%)	304 (66.7%)	< 0.0001
Death or hospice	118 (14.1%)	338 (40.6%)	< 0.0001	-	-	-

Table: Table 1. Demographics and Outcomes

Disclosures:

Dan Park indicated no relevant financial relationships.

Kevin Houston indicated no relevant financial relationships.

Neerav Dharia indicated no relevant financial relationships.

Nikki Duong indicated no relevant financial relationships.

Jasmohan Bajaj indicated no relevant financial relationships.

Dan Park, MD, Kevin Houston, MD, Neerav Dharia, MD, Nikki Duong, MD, Jasmohan Bajaj, MD. B0506 - Infections in Patients With Cirrhosis Have a Changing Profile Over Time and Are Linked to a Higher Risk of Death Compared to Patients Without Cirrhosis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.