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Prevalence, Risk Factors, and Impact of Bacterial or Fungal Infections in Acute Liver Failure Patients from India

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Abstract

Background

We evaluated the prevalence, risk factors, and impact of bacterial/fungal infections in acute liver failure (ALF) patients.

Methods

We analyzed clinical, biochemical, and microbiological data of ALF patients with and without bacterial/fungal infections admitted at an institute over the last 5 years.

Results

We enrolled 143 patients, 50% males, median age 25 years, with acute viral hepatitis (32.2%), drug-induced injury (18.2%), and tropical illness (14%) as aetiologies of ALF. 110 patients (76.9%) developed bacterial/fungal infections [Bacterial infection: MDR: 70%, PDR: 7%, ESBL: 40%, CRE: 30%, CRAB: 26.6%, MDR-EF: 13.3% and fungal infection: 19 (17.3%)].

On univariable analysis, SIRS (33.6% vs.3%), ICU admission (78.2% vs. 45.5%), mechanical ventilation (88.2% vs. 51.5%), inotropes (39.1% vs. 6.1%), invasive catheters (91.8% vs. 39.4%), and prolonged catheterization (6 days vs. 0 days) were significant risk factors for infections (p < 0.05, each). In contrast, SIRS and catheterization independently predicted infection on multivariable regression.

Organ failures [3 (2–4) vs. 1 (0–2)], grade-III–IV HE (67.3% vs. 33.3%), circulatory failure (39.1% vs. 6.1%), coagulopathy (INR > 2.5: 58.2% vs. 33.3%), renal injury (28.2% vs. 6.1%) (p < 0.05), MELD (32.9 ± 8.2 vs. 26.7 ± 8.3) and CPIS [3(2–4) vs. 2(0–2)] were higher in infected vs. non-infected patients (p < 0.001). 30-day survival was significantly lower in infected vs. non-infected patients (17.3% vs. 75.8%, p < 0.001), while no patient survived with fungal infections. Refractory septic shock was the commonest cause of mortality in patients.

Conclusions

Infections due to MDR organisms are high, fungal infections are fatal, and refractory septic shock is the dominant reason for mortality, implying bacterial and fungal infections as the major killer in ALF patients.

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Data Availability

Data are not publicly available but is available by contacting the corresponding author.

Abbreviations

ALF:

Acute liver failure

MDR:

Multidrug-resistant

PDR:

Pandrug-resistant

ESBLs:

Extended spectrum beta-lactamase producing organisms

CRE:

Carbapenem-resistant Enterobacteriaceae

CRAB:

Carbapenem-resistant Acinetobacter baumannii

MDR-ef:

Multidrug-resistant Enterococcus faecium

MELD:

Model for end-stage liver diseases

CPI:

Score, clinical prognostic indicator score

SIRS:

Systemic inflammatory response syndrome

ICU:

Intensive care unit

HE:

Hepatic encephalopathy

INR:

International normalized ratio

BDG:

Beta-D glucan

GMI:

Galactomannan Index

CDC/NHSN:

Centre for disease control and prevention-national heath safety network

EORTC/MSG:

European organization for research and treatment of cancer mycoses study group criteria

CSF:

Cerebrospinal fluid

FNAC:

Fine needle aspiration cytology

CLIF-SOFA:

Chronic liver failure-sequential organ failure assessment

SD:

Standard deviation

IQR:

Interquartile range

MDRO:

Multidrug-resistant organisms

KCC:

King's College criteria

BSI:

Blood stream infections

HEV:

Hepatitis E virus

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Author notes

  1. Parminder Kaur and Nipun Verma have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Parminder Kaur, Nipun Verma, Arun Valsan, Pratibha Garg, Sahaj Rathi, Arka De, Madhumita Premkumar, Sunil Taneja, Ajay Duseja, Virendra Singh & Radha Krishan Dhiman

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  1. Parminder Kaur
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Contributions

NV designed the study, analysed the data, reviewed the manuscript. PK collected the data and drafted the manuscript. AV collected the data and revised the manuscript. PG, SR, AD, MP, ST, AD, VS, RKD revised and reviewed the manuscript. All the authors approved the final manuscript.

Corresponding author

Correspondence to Nipun Verma.

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Conflict of interest

The authors have not disclosed any competing interests.

Ethical approval

This study was approved by ethics committee of Postgraduate Institute of Medical Education and Research, Chandigarh, India (NK/7445/Study/582).

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Kaur, P., Verma, N., Valsan, A. et al. Prevalence, Risk Factors, and Impact of Bacterial or Fungal Infections in Acute Liver Failure Patients from India. Dig Dis Sci 68, 4022–4038 (2023). https://doi.org/10.1007/s10620-023-07971-9

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  • DOI: https://doi.org/10.1007/s10620-023-07971-9

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