Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study
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Background and aims
Spontaneous bacteremia is a poorly characterized infection in patients with cirrhosis. We compared the incidence of mortality and acute kidney injury in patients with spontaneous bacterial peritonitis and spontaneous bacteremia, and identified risk factors for mortality and acute kidney injury in patients with spontaneous bacteremia.
We performed a retrospective cohort study of patients with cirrhosis and spontaneous bacteremia or spontaneous bacterial peritonitis from 2008 to 2016 at Hospital Italiano, Buenos Aires. We compared the cumulative incidence of acute kidney injury and death between the two infections, and identified risk factors for these outcomes in patients with spontaneous bacteremia.
Seventy-one patients with spontaneous bacteremia and 55 patients with spontaneous bacterial peritonitis were included. Most infections were nosocomial. Overall, 26% of bacteria were resistant and 11% multi-resistant. We found no significant association between acute kidney injury [subhazard ratio (sHR) 1.05 (95% confidence interval, CI 0.67–1.63, p = 0.83)] or death [sHR 1.15 (95% CI 0.60–2.20, p = 0.68)] and type of spontaneous infection in multivariate analyses adjusting for basal Model for End-Stage Liver Disease (MELD) score. In patients with spontaneous bacteremia, baseline MELD score was independently associated with acute kidney injury [sHR 1.07 (95% CI 1.03–1.11, p = 0.001)] and death [sHR 1.07 (95% CI 1.02–1.15, p = 0.03)].
Short-term acute kidney injury and mortality rates were similar in patients with spontaneous bacteremia and spontaneous bacterial peritonitis. Risk assessment of patients with spontaneous bacteremia can be performed with baseline MELD score.
KeywordsSpontaneous bacteremia Spontaneous bacterial peritonitis Outcome Acute kidney injury Mortality
Acute-on-chronic liver failure
Acute kidney injury
Model for End-Stage Liver Disease
Methicillin-resistant Staphylococcus aureus
We are grateful to Martín O’Flaherty and Matías Tisi Baña for helpful advice and suggestions about the manuscript.
Sebastián Marciano and Melisa Dirchwolf designed the research study and wrote the paper; Carla S. Bermudez, Natalia Sobenko, Leila Haddad, Federico Genre Bert, Laura Barcán, and Astrid Smud performed the research and collected the data; Maria L. Posadas-Martínez and Diego Giunta analyzed the data and provided critical insight; Adrián Gadano contributed to study design and revised/corrected the final manuscript. All authors approved the final version of the manuscript including the authorship list.
Compliance with ethical standards
Conflict of interest
Sebastián Marciano, Melisa Dirchwolf, Carla S. Bermudez, Natalia Sobenko, Leila Haddad, Federico Genre Bert, Laura Barcán, Astrid Smud, Maria Lourdes Posadas-Martínez, Diego Giunta, and Adrián Gadano declare that they do not have any conflicts of interest.
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