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Risk factors for mortality in cirrhotic patients with sepsis

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Abstract

Background

Patients with cirrhosis and sepsis had increased mortality.

Aim

Determine factors associated with increased in-hospital mortality in cirrhotic patients admitted for sepsis.

Methods

All cirrhotic patients admitted from 2004 to 2007 for sepsis were identified from hospital electronic database. Patients were included if they had liver cirrhosis and sepsis, defined as identified sources of infection, and at least one of fever, altered total white cell count, or raised C-reactive protein. Baseline characteristics, investigations, infections, and outcomes were collected. Main outcome measure was in-hospital mortality.

Results

A total of 205 admissions in 153 patients were included. In-hospital mortality rate was 24.4%. In predicting in-hospital death, area under the receiver-operating-characteristic curve for Child-Pugh score was 0.934, with optimum cut-off at 10 and above, while for model for end-stage liver disease (MELD) score was 0.751, with optimum cut-off at 17 and above. Four factors were significantly associated with in-hospital mortality on multivariate analysis: presence of >1 site of infection, pneumonia, Child’s C status, and MELD score 17 and above. In-hospital mortality rate increased with more factors: 0% with no factor, 7% with one factor, 21% with two factors, 87% with three factors, and 100% with four factors. The mortality of those with <3 risk factors was significantly lower than those with three or more risk factors (7 vs. 91%, p = 0.000).

Conclusions

Septic cirrhotic patients with pneumonia, >1 site of infection, Child’s C cirrhosis, and high MELD score had a high mortality risk.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore

    Lee-Guan Lim, Shu-Jeng Woo, Yock-Young Dan, Yin-Mei Lee, Vincent Lai & Seng-Gee Lim

  2. National University of Singapore High School, Singapore, Singapore

    Xiang-Xuan Eunice Tan

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  1. Lee-Guan Lim
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  2. Xiang-Xuan Eunice Tan
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  3. Shu-Jeng Woo
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  4. Yock-Young Dan
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  5. Yin-Mei Lee
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  6. Vincent Lai
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  7. Seng-Gee Lim
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Correspondence to Seng-Gee Lim.

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Lim, LG., Tan, XX.E., Woo, SJ. et al. Risk factors for mortality in cirrhotic patients with sepsis. Hepatol Int 5, 800–807 (2011). https://doi.org/10.1007/s12072-011-9258-y

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  • DOI: https://doi.org/10.1007/s12072-011-9258-y

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