Safety and efficacy of antibiotics among acutely decompensated cirrhosis patients.
J Gastroenterol Hepatol. 2018 Apr 26;:
Authors: Habib S, Patel N, Yarlagadda S, Hsu CH, Patel S, Schader L, Walker C, Twesigye I
BACKGROUND AND AIM: Infection is a leading precipitant of acute-on-chronic liver failure. We aim to determine the safety and efficacy of antibiotics within acute-on-chronic liver failure.
METHODS: Retrospective study of 457 acute-on-chronic liver failure patients, admitted to the University of Arizona Health Network between January 1 and December 31, 2014. Eligibility criteria were: at least 18 years of age and six months follow-up, data available to calculate systemic inflammatory response syndrome, and acute-on-chronic liver failure. We collected patient's clinical features and historical data. Key data points were: infection, antibiotic use, and systemic inflammatory response syndrome. We used cox proportional hazards to model the effects of clinical factors on risk of death.
RESULTS: 521 of 1243 met the inclusion criteria, 64 had missing data, leaving 457 patients. Infection resulted in higher hazard (HR=1.6, CI: 1.1-1.3, p=0.01). Patients with infections and antibiotics, compared to non-infected patients without antibiotics, had higher hazard (HR=1.633, CI: 1.022-2.609, p=.04). Of those infected patients with antibiotics, systemic inflammatory response syndrome patients experienced higher hazard (HR=1.9, CI: 1.1-3.0, p=.007). Multivariable cox proportional hazards associated the following with higher hazard: systemic inflammatory response syndrome (HR=1.866, CI: 1.242-2.804, p=0.003), vancomycin (HR=1.640, CI: 1.119-2.405, p=0.011), Model of End-Stage Liver Disease (HR = 1.051, CI: 1.030-1.073, p<0.001), gastrointestinal bleeding (HR=1.727, CI: 1.180-2.527, p=0.005), and hepatic encephalopathy (HR=1.807, CI: 1.247-2.618, p=0.002).
CONCLUSION: Overall, treatment of infection with antibiotics did not improve survival, however patients not meeting SIRS criteria had better outcome and vancomycin was associated with poorer survival among acute-on-chronic liver failure patients.
PMID: 29697158 [PubMed - as supplied by publisher]