Overt hepatic encephalopathy predisposes cirrhotic patients with AD to de novo infection

Cirrhotic patients with acute decompensation (AD) are at heightened risk of de novo infection during hospitalization, specifically in the presence of overt hepatic encephalopathy (HE), a study has found.

The study included 759 consecutive patients (74 percent male) admitted across two institutions. Researchers collected data on infection and HE on the day of admission. They monitored the patients for the development of de novo infections over 28 days afterwards. The European Association for the Study of the Liver-Chronic Liver Failure classification system was used to determine the presence of organ failures.

Patients were grouped into four: no baseline overt HE or infection (n=352; group 1); overt HE with no baseline infection (n=221; group 2); no overt HE but with baseline infection (n=100; group 3); and overt HE with baseline infection (n=86; group 4). The median age of patients in the respective groups was 43.9, 45.6, 44.8, and 48.7 years.

Alcohol was the most common aetiology of cirrhosis (55.1 percent), followed by hepatitis B (11.7 percent). A total of 452 patients (59.6 percent) had no or mild HE (grade 0/1). 

On multivariate logistic regression analyses, the risk of de novo infection was positively associated with overt HE (odds ratio [OR], 1.532, 95 percent confidence interval [CI], 1.061–2.300; p=0.024) and admission to intensive care unit (OR, 2.303, 95 percent CI, 1.508–3.517; p<0.001).

The 28-day mortality was 25.3 percent, 60.2 percent, 55.0 percent, and 72.1 percent in groups 1 to 4, respectively. Age, international normalized ratio, and creatinine emerged as independent predictors of mortality. Furthermore, the presence of overt HE, infection, coagulation, kidney, circulatory, respiratory, and liver failures contributed to increased mortality.

The findings highlight the need for regular surveillance with a low threshold to start antibiotics early among patients with overt HE.