Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections

IntroductionPatients with cirrhosis have a high risk of sepsis, which confers a poor prognosis. The systemic inflammatory response syndrome (SIRS) criteria have several limitations in cirrhosis. Recently, new criteria for sepsis (Sepsis-3) have been suggested in the general population (increase of Sequential Organ Failure Assessment (SOFA) ≥2 points from baseline). Outside the intensive care unit (ICU), the quick SOFA (qSOFA (at least two among alteration in mental status, systolic blood pressure ≤100 mm Hg or respiratory rate ≥22/min)) was suggested to screen for sepsis. These criteria have never been evaluated in patients with cirrhosis. The aim of the study was to assess the ability of Sepsis-3 criteria in predicting in-hospital mortality in patients with cirrhosis and bacterial/fungal infections.Methods259 consecutive patients with cirrhosis and bacterial/fungal infections were prospectively included. Demographic, laboratory and microbiological data were collected at diagnosis of infection. Baseline SOFA was assessed using preadmission data. Patients were followed up until death, liver transplantation or discharge. Findings were externally validated (197 patients).ResultsSepsis-3 and qSOFA had significantly greater discrimination for in-hospital mortality (area under the receiver operating characteristic (AUROC)=0.784 and 0.732, respectively) than SIRS (AUROC=0.606) (p<0.01 for both). Similar results were observed in the validation cohort. Sepsis-3 (subdistribution HR (sHR)=5.47; p=0.006), qSOFA (sHR=1.99; p=0.020), Chronic Liver Failure Consortium Acute Decompensation score (sHR=1.05; p=0.001) and C reactive protein (sHR=1.01;p=0.034) were found to be independent predictors of in-hospital mortality. Patients with Sepsis-3 had higher incidence of acute-on-chronic liver failure, septic shock and transfer to ICU than those without Sepsis-3.ConclusionsSepsis-3 criteria are more accurate than SIRS criteria in predicting the severity of infections in patients with cirrhosis. qSOFA is a useful bedside tool to assess risk for worse outcomes in these patients. Patients with Sepsis-3 and positive qSOFA deserve more intensive management and strict surveillance.

Download Full-text

Applicability of the Chronic Liver Failure-Consortium score in patients with cirrhosis and bacterial infections: a single-clinic experience

GASTROENTEROLOGY ◽

10.22141/2308-2097.55.4.2021.247915 ◽

2021 ◽

Vol 55 (4) ◽

pp. 239-245

Author(s):

D.I. Haurylenka ◽

N.N. Silivontchik

Keyword(s):

Liver Failure ◽

Bacterial Infections ◽

Serum Bilirubin Level ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Acute Decompensation ◽

Clinic Experience ◽

Cirrhotic Patients ◽

The City ◽

Number Needed To Harm

Background. The frequency and characteristics of acute-on-chronic liver failure (ACLF) are reported in numerous articles from different countries. The aim of the study was to assess the cirrhosis decompensation in patients with bacterial infections based on the Chronic Liver Failure-Consortium (CLIF-C) score in one of the city clinics in Belarus. Materials and methods. The patients underwent laboratory and instrumental studies during the hospitalization. The assessment of the syndrome of acute-on-chronic liver failure was performed using the CLIF-C score. Bacterial infections were diagnosed on the basis of standard criteria. Results. The study included 151 cirrhotic patients, 87 males and 64 females. Median age was 55 years (Q1 = 43; Q3 = 61). Cirrhosis was predominantly due to alcohol addiction — 83 patients (55 %). ACLF was diagnosed in 44 of 151 patients with cirrhosis (29.1 %; 95% confidence interval (CI) 22.0–37.1). Bacterial infections were detected in 67 people (44.4 %; 95% CI 36.3–52.7). Most often patients had liver failure that was detected by an increase in serum bilirubin level. Among individuals with upper gastrointestinal bleedings, number needed to harm for developing ACLF was 3.3 (95% CI 2.2–4.4). The risk of developing ACLF grade 2 and 3 in cirrhotic patients with infections was 8.2, with 95% CI 1.0–69.6 (number needed to harm was 12.9; 95% CI 10.7–15.0). Bacterial infections increase the risk of acute decompensation in patients with cirrhosis (odds ratio = 2.0, p = 0.048). Conclusions. The CLIF-C score is quite applicable in our cohort of patients with cirrhosis.

Download Full-text

Bacterial infections with and without acute-on-chronic liver failure in patients with cirrhosis and acute decompensation: Risk factors and outcome

Digestive and Liver Disease ◽

10.1016/j.dld.2018.01.021 ◽

2018 ◽

Vol 50 (1) ◽

pp. 10 ◽

Cited By ~ 1

Author(s):

M. Bartoletti ◽

M. Baldassarre ◽

M. Domenicali ◽

R. Lewis ◽

M. Giannella ◽

...

Keyword(s):

Risk Factors ◽

Liver Failure ◽

Bacterial Infections ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Acute Decompensation

Download Full-text

Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis

Gut ◽

10.1136/gutjnl-2017-314240 ◽

2017 ◽

Vol 67 (10) ◽

pp. 1870-1880 ◽

Cited By ~ 131

Author(s):

Javier Fernández ◽

Juan Acevedo ◽

Reiner Wiest ◽

Thierry Gustot ◽

Alex Amoros ◽

...

Keyword(s):

Liver Failure ◽

Systemic Inflammation ◽

Bacterial Infections ◽

Clinical Course ◽

Fungal Infections ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Bacterial Peritonitis ◽

Probability Of Survival

Bacterial infection is a frequent trigger of acute-on-chronic liver failure (ACLF), syndrome that could also increase the risk of infection. This investigation evaluated prevalence and characteristics of bacterial and fungal infections causing and complicating ACLF, predictors of follow-up bacterial infections and impact of bacterial infections on survival.Patients407 patients with ACLF and 235 patients with acute decompensation (AD).Results152 patients (37%) presented bacterial infections at ACLF diagnosis; 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections during follow-up (4 weeks). The corresponding figures in patients with AD were 25% and 18% (p<0.001). Severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent in patients with ACLF. Patients with ACLF and bacterial infections (either at diagnosis or during follow-up) showed higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p<0.001) and lower 90-day probability of survival (49% vs 72.5%;p<0.001) than patients with ACLF without infection. Bacterial infections were independently associated with mortality in patients with ACLF-1 and ACLF-2. Fungal infections developed in 9 patients with ACLF (2%) and in none with AD, occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%).ConclusionBacterial infections are extremely frequent in ACLF. They are severe and associated with intense systemic inflammation, poor clinical course and high mortality. Patients with ACLF are highly predisposed to develop bacterial infections within a short follow-up period and could benefit from prophylactic strategies.

Download Full-text

Outcome of bacterial infections complicated or not by acute-on-chronic liver failure in patients with cirrhosis admitted to hospital for acute decompensation

Journal of Hepatology ◽

10.1016/s0168-8278(18)30709-8 ◽

2018 ◽

Vol 68 ◽

pp. S248

Author(s):

M. Bartoletti ◽

M. Baldassarre ◽

M. Domenicali ◽

M. Rinaldi ◽

M. Giannella ◽

...

Keyword(s):

Liver Failure ◽

Bacterial Infections ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Acute Decompensation

Download Full-text

Faculty Opinions recommendation of Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725855163.793510689 ◽

2015 ◽

Author(s):

Tilman Sauerbruch

Keyword(s):

Acute Kidney Injury ◽

Liver Failure ◽

Kidney Injury ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Acute Decompensation

Download Full-text

Acute Decompensation and Acute-on-Chronic Liver Failure

Clinics in Liver Disease ◽

10.1016/j.cld.2021.01.009 ◽

2021 ◽

Author(s):

Philip Ferstl ◽

Jonel Trebicka

Keyword(s):

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Acute Decompensation

Download Full-text

Characterizing bacterial infections in acute-on-chronic liver failure among patients with cirrhosis from nonalcoholic steatohepatitis

Journal of Hepatology ◽

10.1016/j.jhep.2021.04.006 ◽

2021 ◽

Author(s):

Vinay Sundaram

Keyword(s):

Liver Failure ◽

Nonalcoholic Steatohepatitis ◽

Bacterial Infections ◽

Chronic Liver ◽

Chronic Liver Failure

Download Full-text

The Prediction of in‐Hospital Mortality in Decompensated Cirrhosis with Acute‐on‐Chronic Liver Failure

Liver Transplantation ◽

10.1002/lt.26311 ◽

2021 ◽

Author(s):

Florence Wong ◽

K Rajender Reddy ◽

Puneeta Tandon ◽

Jennifer C Lai ◽

Nishita Jagarlamudi ◽

...

Keyword(s):

Hospital Mortality ◽

Liver Failure ◽

Chronic Liver ◽

Decompensated Cirrhosis ◽

Chronic Liver Failure

Download Full-text

Inhibition of glutamine synthetase in monocytes from patients with acute-on-chronic liver failure resuscitates their antibacterial and inflammatory capacity

Gut ◽

10.1136/gutjnl-2018-316888 ◽

2018 ◽

Vol 68 (10) ◽

pp. 1872-1883 ◽

Cited By ~ 16

Author(s):

Hannelie Korf ◽

Johannie du Plessis ◽

Jos van Pelt ◽

Sofie De Groote ◽

David Cassiman ◽

...

Keyword(s):

Glutamine Synthetase ◽

Liver Failure ◽

Bacterial Infections ◽

Chronic Liver ◽

Decompensated Cirrhosis ◽

Chronic Liver Failure ◽

Phenotypic Characterisation ◽

Severity Scores ◽

Aclf Patient

ObjectiveAcute-on-chronic liver failure (ACLF) is associated with dysfunctional circulating monocytes whereby patients become highly susceptible to bacterial infections. Here, we identify the pathways underlying monocyte dysfunction in ACLF and we investigate whether metabolic rewiring reinstates their phagocytic and inflammatory capacity.DesignFollowing phenotypic characterisation, we performed RNA sequencing on CD14+CD16− monocytes from patients with ACLF and decompensated alcoholic cirrhosis. Additionally, an in vitro model mimicking ACLF patient-derived features was implemented to investigate the efficacy of metabolic regulators on monocyte function.ResultsMonocytes from patients with ACLF featured elevated frequencies of interleukin (IL)-10-producing cells, reduced human leucocyte antigen DR isotype (HLA-DR) expression and impaired phagocytic and oxidative burst capacity. Transcriptional profiling of isolated CD14+CD16− monocytes in ACLF revealed upregulation of an array of immunosuppressive parameters and compromised antibacterial and antigen presentation machinery. In contrast, monocytes in decompensated cirrhosis showed intact capacity to respond to inflammatory triggers. Culturing healthy monocytes in ACLF plasma mimicked the immunosuppressive characteristics observed in patients, inducing a blunted phagocytic response and metabolic program associated with a tolerant state. Metabolic rewiring of the cells using a pharmacological inhibitor of glutamine synthetase, partially restored the phagocytic and inflammatory capacity of in vitro generated- as well as ACLF patient-derived monocytes. Highlighting its biological relevance, the glutamine synthetase/glutaminase ratio of ACLF patient-derived monocytes positively correlated with disease severity scores.ConclusionIn ACLF, monocytes feature a distinct transcriptional profile, polarised towards an immunotolerant state and altered metabolism. We demonstrated that metabolic rewiring of ACLF monocytes partially revives their function, opening up new options for therapeutic targeting in these patients.

Download Full-text