Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study

Anand Kulkarni; Kalyan Rakam; Mahathi Avadhanam; Yogita V P; Chinmayee Rachakonda; Anveshi Satyavadi; Asim A Zuberi; Santhosh Reddy; Sowmya Iyengar; Anand Gupta; Mithun Sharma; Nagaraja R Padaki; Reddy Rajender; Nageshwar Reddy Duvvur

doi:10.7759/cureus.47151

Predictors and Outcomes of Infections in ICU Patients With Cirrhosis: A Single-Center Observational Study

Cureus. 2023 Oct 16;15(10):e47151. doi: 10.7759/cureus.47151. eCollection 2023 Oct.

Affiliations

¹ Hepatology, Asian Institute of Gastroenterology (AIG), Hyderabad, IND.
² Critical Care Medicine, Asian Institute of Gastroenterology (AIG), Hyderabad, IND.
³ Clinical Pharmacy, Asian Institute of Gastroenterology (AIG), Hyderabad, IND.
⁴ Perelman School of Medicine, University of Pennsylvania, Philadephia, USA.
⁵ Gastroenterology, Asian Institute of Gastroenterology (AIG), Hyderabad, IND.

Abstract

Background: Patients with cirrhosis are susceptible to infections, especially by multidrug-resistant organisms (MDROs). There are limited data on the incidence of culture-positive infections and the validity of Sepsis 3-criteria in patients with cirrhosis admitted to the intensive care unit (ICU) in India, which we aimed to assess.

Methods: In this prospective study, we included consecutive patients with cirrhosis admitted to the ICU between November 1, 2021, and April 30, 2022. The primary objective was to compare the outcomes of patients with microbiologically proven infections with those without proven infections. The secondary objective was to assess the predictors of infections and mortality and the impact of drug-resistant organisms.

Results: A total of 298 patients (9.4% women) were included. The incidence of microbiologically proven infection was 34% (101/298; 95%CI=27.6-41.2). Most patients (61%) had healthcare-associated infections, Gram-negative organisms accounted for 75.3%, and bacteremia was the commonest site. Drug-resistant organisms accounted for 52.5% (53/101; 95%CI=39.3-68.7), of which 39.6% were multidrug-resistant (MDR) and 12.8% were extensively drug-resistant (XDR). Mortality was significantly higher in patients with proven infections than those without (61.4% vs. 44.2%; P=0.007). The sequential organ failure assessment (SOFA) score (OR=1.91; 95%CI=1.04-3.52; P<0.001) and presence of fever and/or positive quick SOFA (qSOFA; OR=1.91;1.04-3.52; P=0.03) were associated with an increased risk of infections. The SOFA score (OR=1.06;95%CI=1.002-1.12; P=0.04), MELD NA score (OR=1.08;95%CI=1.05-1.12; P<0.001), and presence of fever and/or positive qSOFA (OR=2.19; 95%CI=1.27-3.76; P=0.005) predicted mortality.

Conclusions: One-third of the patients with cirrhosis admitted to the ICU had microbiologically proven infection, and the mortality rate in such patients was high. SOFA, qSOFA, and fever can predict microbiologically proven infections and mortality in patients with cirrhosis.

Keywords: fever; multidrug-resistant infections; norfloxacin prophylaxis; sepsis-3 criteria; sofa score.