Short-term Prognosis of Community-Acquired Bacteremia in Patients with Liver Cirrhosis or Alcoholism: A Population-Based Cohort Study

Authors


  • The study was supported by the Danish Research Council (Journal No. 22-03-0055). (Research at the Department of Clinical Microbiology, Aarhus University Hospital, section Aalborg, is supported by a grant from the fund “Det Obelske Familiefond.”)

Reprint requests: Gitte Linderoth, MD, Department of Clinical Epidemiology, Ole Worms Allé 150, DK-8000 Aarhus C, Denmark; Fax: +45 8942 4801; E-mail: gl@dce.au.dk

Abstract

Background: Liver cirrhosis is associated with an increased risk of infection and a poor prognosis, but the role of alcoholism in these outcomes is uncertain. This study looks at the short-term prognosis for bacteremia in patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism, compared with the prognosis for other bacteremia cases.

Methods: All patients who were hospitalized with their first community-acquired bacteremia in North Jutland County, Denmark, in the period 1992 to 2002 were retrieved from a population-based bacteremia registry. Denmark's Hospital Discharge Registry then allowed us to disaggregate these patients into the following groups: 47 patients with alcoholic liver cirrhosis, 19 with nonalcoholic liver cirrhosis, 190 with alcoholism, and a comparison group of 3,535 other bacteremia cases. Using logistic regression, we estimated odds ratios (ORs) for 30-day case fatality for the main study variable, adjusted for gender, age, focus of infection, and comorbidity.

Results: The case fatality rate (CFR) was 43% for patients with alcoholic liver cirrhosis, 32% for patients with nonalcoholic liver cirrhosis, 24% for patients with alcoholism, and 15% for other bacteremia patients. The adjusted OR estimates for patients with alcoholic liver cirrhosis, nonalcoholic liver cirrhosis, and alcoholism compared with other bacteremia cases were 6.3 (95% CI 3.3–11.7), 2.4 (95% CI 0.9–6.7), and 2.5 (95% CI 1.7–3.7), respectively. Focus of infection and group of bacteria did not noticeably affect the increased CFR.

Conclusion: Liver cirrhosis and alcoholism were associated with a poor short-term prognosis for community-acquired bacteremia. Liver cirrhosis and alcoholism may have independent effects on the prognosis for patients with liver cirrhosis and bacteremia.

Ancillary