Study of infections in decompensated liver cirrhosis in North India

Introduction: Cirrhosis of liver is an acquired immunocompromised state. The development of infection in cirrhosis is associated with significantly higher mortality that has been shown to be independent of the severity of liver disease. The in-hospital mortality of cirrhotic patients with infection is approximately 4-5 folds higher than that of patients without infection cirrhosis and is directly responsible for 30–50% of deaths. This study was planned to study clinical profile of common infections in decompensated cirrhosis of liver patients Aims and objectives: This study aims to determine the clinical profile of infections in decompensated cirrhosis of the liver with main objectives: a) Finding various causative organisms of common infections in decompensated cirrhosis of liver b) To study the possible risk factors associated with infections in decompensated cirrhosis liver c) To study the impact of infections in the outcome of patients with decompensated cirrhosis of the liver. Methods: All patients attending Medical or Gastroenterology OPD were screened for decompensated cirrhosis of liver. They were clinically examined for evidence of any focus or site of infection. These patients were admitted and underwent estimation of hemogram, liver function tests, renal function tests, serum electrolytes, serum CRP and procalcitonin, urine routine and microscopic examination, urine culture, stool routine or microscopic examination, blood culture, ascitic fluid analysis chest X-ray and ultrasonography abdomen. These patients were followed up for 30 days. Results: There was a higher prevalence of culture positive in alcoholic cirrhotic patients in comparison with nonalcoholic cirrhotic with p value of 0.01. The mortality after 30 days of follow up was 1.2%. There was no statistically significant difference found in the mortality of the patients seen. In this study, cirrhotic patients with smoking history, associated with other co morbidities, presence of fever at the time of presentation, jaundice, presence of spontaneous bacterial peritonitis and body fluids showing positive cultures are predictors of bad outcome. Among 117 (69.2%) alcohol related decompensated liver cirrhosis patients 66.7% had worst outcome. Conclusion: The most common infection in decompensated cirrhosis of liver found was spontaneous bacterial peritonitis. The 30 days outcome of infection in DLF was 98.8% in this study. The common risk factor for infection in DLF was alcohol as etiology and development of SBP. The study concludes that infections are more common in alcohol related cirrhosis than others