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Evaluation of prognostic scoring systems in liver cirrhosis patients with bloodstream infection.

Abstract Patients with cirrhosis are at increased risk of developing bloodstream infections (BSIs), and the short-term mortality rate in those patients is high. The aim of this study was to compare the different scoring models to predict mortality in cirrhotic patients with BSIs.A total of 222 cirrhotic patients with BSIs were retrospectively included in the study. The demographic, clinical, and microbiologic data were collected and patients were followed for at least 28 days after blood cultures were established. A multivariable Cox proportional hazard model was used to identify independent risk factors for 28-day all-cause mortality. The prognostic accuracy of different scoring models (chronic liver failure-organ failure [CLIF-OF], model for end-stage liver disease [MELD], systemic inflammatory response syndrome [SIRS], and Pitt scores) were compared with the C-index and receiver operating characteristic curve (ROC).Forty deaths were recorded on day 28 after blood cultures were established. Male sex (hazard ratio [HR] = 2.75, 95% confidence interval [CI] = 1.10-6.86), international normalized ratio (INR) (HR = 1.76, 95% CI = 1.35-2.30), serum bilirubin (HR = 1.002, 95% CI = 1.000-1.003), circulation failure (HR = 3.56, 95% CI = 1.63-7.79), lung failure (HR = 2.23, 95% CI = 1.09-4.57), and non-primary BSI source (HR = 2.27, 95% CI = 1.09-4.73) were identified as independent risk factors for mortality in cirrhotic patients with BSIs. In predicting 28-day mortality, CLIF-OF and MELD scores had significantly high C-indices (0.79 and 0.76, respectively) and ROC values (0.786 and 0.782, respectively) compared with Pitt and SIRS scores (C-indices: 0.61 and 0.57, respectively; ROC values: 0.591 and 0.637, respectively).Cirrhotic patients with BSIs had high short-term mortality rates. Our data suggested that both CLIF-OF and MELD scores can be used to predict the short-term prognosis of these patients.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390273
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Evaluation of prognostic scoring systems in liver cirrhosis patients with
      bloodstream infection.
PG  - e8844
LID - 10.1097/MD.0000000000008844 [doi]
AB  - Patients with cirrhosis are at increased risk of developing bloodstream
      infections (BSIs), and the short-term mortality rate in those patients is high.
      The aim of this study was to compare the different scoring models to predict
      mortality in cirrhotic patients with BSIs.A total of 222 cirrhotic patients with 
      BSIs were retrospectively included in the study. The demographic, clinical, and
      microbiologic data were collected and patients were followed for at least 28 days
      after blood cultures were established. A multivariable Cox proportional hazard
      model was used to identify independent risk factors for 28-day all-cause
      mortality. The prognostic accuracy of different scoring models (chronic liver
      failure-organ failure [CLIF-OF], model for end-stage liver disease [MELD],
      systemic inflammatory response syndrome [SIRS], and Pitt scores) were compared
      with the C-index and receiver operating characteristic curve (ROC).Forty deaths
      were recorded on day 28 after blood cultures were established. Male sex (hazard
      ratio [HR] = 2.75, 95% confidence interval [CI] = 1.10-6.86), international
      normalized ratio (INR) (HR = 1.76, 95% CI = 1.35-2.30), serum bilirubin (HR =
      1.002, 95% CI = 1.000-1.003), circulation failure (HR = 3.56, 95% CI =
      1.63-7.79), lung failure (HR = 2.23, 95% CI = 1.09-4.57), and non-primary BSI
      source (HR = 2.27, 95% CI = 1.09-4.73) were identified as independent risk
      factors for mortality in cirrhotic patients with BSIs. In predicting 28-day
      mortality, CLIF-OF and MELD scores had significantly high C-indices (0.79 and
      0.76, respectively) and ROC values (0.786 and 0.782, respectively) compared with 
      Pitt and SIRS scores (C-indices: 0.61 and 0.57, respectively; ROC values: 0.591
      and 0.637, respectively).Cirrhotic patients with BSIs had high short-term
      mortality rates. Our data suggested that both CLIF-OF and MELD scores can be used
      to predict the short-term prognosis of these patients.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Zhao, Hong
AU  - Zhao H
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Disease, The First Affiliated Hospital, Zhejiang University School of Medicine,
      Hangzhou.
FAU - Gu, Xiuling
AU  - Gu X
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Disease, The First Affiliated Hospital, Zhejiang University School of Medicine,
      Hangzhou.
AD  - Department of infectious diseases, Cixi People's Hospital, Cixi, China.
FAU - Zhao, Ruihong
AU  - Zhao R
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Disease, The First Affiliated Hospital, Zhejiang University School of Medicine,
      Hangzhou.
FAU - Shi, Yu
AU  - Shi Y
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Disease, The First Affiliated Hospital, Zhejiang University School of Medicine,
      Hangzhou.
FAU - Sheng, Jifang
AU  - Sheng J
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Disease, The First Affiliated Hospital, Zhejiang University School of Medicine,
      Hangzhou.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Bacterial Agents)
SB  - AIM
SB  - IM
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Bacteremia/drug therapy/*microbiology/*mortality
MH  - Biopsy
MH  - Female
MH  - Humans
MH  - Liver Cirrhosis/*complications/*mortality/virology
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000008844 [doi]
AID - 00005792-201712150-00023 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e8844. doi: 10.1097/MD.0000000000008844.