Fernandez J, et al. - Physicians designed this study to assess prevalence and characteristics of bacterial and fungal infections causing and complicating acute-on-chronic liver failure (ACLF), predictors of follow-up bacterial infections and effect of bacterial infections on survival. In ACLF, bacterial infections were extremely frequent. These infections were found to be severe and associated with intense systemic inflammation, poor clinical course, and high mortality. Within a short follow-up period, patients with ACLF were highly predisposed to develop bacterial infections and could benefit from prophylactic strategies.

Methods

• The physicians enrolled 407 patients with ACLF and 235 patients with acute decompensation (AD) in this study.

Results

• At ACLF diagnosis, 152 patients (37%) presented bacterial infections.
• During follow-up (4 weeks), 46%(n=117) of the remaining 255 patients with ACLF developed bacterial infections.
• In patients with AD, the corresponding figures were 25% and 18% (p < 0.001).
• Among patients with ACLF, severe infections (spontaneous bacterial peritonitis, pneumonia, severe sepsis/shock, nosocomial infections and infections caused by multiresistant organisms) were more prevalent.
• Compared to patients with ACLF without infection, patients with ACLF and bacterial infections (either at diagnosis or during follow-up) demonstrated a higher grade of systemic inflammation at diagnosis of the syndrome, worse clinical course (ACLF 2-3 at final assessment: 47% vs 26%; p < 0.001) and lower 90-day probability of survival (49% vs 72.5%; p < 0.001).
• In patients with ACLF-1 and ACLF-2, bacterial infections were independently correlated with mortality.
• In this study, fungal infections developed in 9 patients with ACLF (2%) and in none with AD.
• It occurred mainly after ACLF diagnosis (78%) and had high 90-day mortality (71%).