[Factors predicting mortality in infected hospitalized cirrhotics patients: about 97 cases].

BACKGROUND

Infections are frequent in cirrhotic patients. They are potentially severe, modifying pejoratively the natural history of the cirrhosis and are suppliers of a heavy mortality.

OBJECTIVE

To determine the predictive factors of hospital mortality in cirrhotic infected patients.

METHODS

We conducted a retrospective study including 97 cirrhotic patients hospitalized in the department of gastroenterology of Charles Nicolle's hospital, for a first infectious episode and not having received antibiotics in the previous 15 days. Clinico-biological, bacteriological, therapeutic and evolutionary data were collected. Scores were adopted and calculated such as the score of Child-Pugh, the score MELD (The Model for End-Stage Liver Disease) and the score SOFA (Sequential Organ Failure Assessment). These data allowed a descriptive study and an uni and multi-varied analysis.

RESULTS

The median age of the studied population was of 59 ± 12 years with a sex ratio of 0.83. The diabetes was the comorbidity most frequently associated with the cirrhosis (26.8 % of the cases) Viral aetiology of the cirrhosis was dominant (3/4 of the cases) especially the virus C (62.5 % of the cases). The clinical presentation of the infection was polymorphic with presence of symptoms connected to the infection and the other connected to the progression of the liver disease. The fever was absent in 3/4 of the cases. The identified infections were, in order of frequency, urinary, infection of ascite, bronchopulmonary, cutaneous and gynecological. The responsible germs were especially bacilli gram negative of intestinal origin. The estimated scores of gravity were: a score of Child-Pugh C in 60 % of the cases, an average score MELD in 18±8 points and a score average SOFA in 8 ± 4 points. Multivariate study found that only encephalopathy, bilirubin level more than 40 μmol/l and creatinin level more than 120 μmol/l was independent factors predicting mortality.

CONCLUSIONS

Infection in cirrhotic patients was a severe and mortal complication. The hepatic encephalopathy, the hyper bilirubinemia and the renal failure are predictive of the hospital mortality. The use of the scores of gravity: Child-Pugh, MELD and SOFA would an important help for the decision to admit in intensive care unit any infected cirrhotic patient.