SAN DIEGO — Sepsis has become a leading cause of death for hospitalized patients with cirrhosis, according to a retrospective cohort study.
Overall mortality from cirrhosis is high, but mortality due to variceal bleeding is declining, Dr. Suraj Naik reported at Digestive Disease Week.
He and his colleagues hypothesized that as treatment of variceal bleeding has improved, the leading cause of in-hospital mortality for cirrhotic patients has shifted.
They studied two specific time periods at Parkland Memorial Hospital in Dallas: 1983–1985 and 2003–2005. Patients were identified by ICD9 codes for any and all causes of cirrhosis. The condition was defined by clinical history, physical findings, and laboratory measures. The cause of death was defined by diagnoses in clinical data and death summaries.
In 1983–1985, there were 610 patients admitted to Parkland with confirmed cirrhosis; 163 (27%) died in-hospital. In 2003–2005, there were 1,187 patients admitted and 241 (20%) died in-hospital. The two cohorts were matched in gender, race, and age (the average age was 50 years in the first group and 53 years in the later group). In 1983–1985, the most common cause of death was variceal bleed (49 patients, or 8%), followed by sepsis (43 patients, or 7%), and liver failure/hepatorenal syndrome (14 patients, or 2%). In 2003–2005, the most common cause of death was sepsis (97 patients, or 8%), followed by variceal bleed (31 patients, or 3%) and liver failure (23 patients, or 2%).
Overall mortality decreased from the first to the second cohort by 22%, and death due to variceal bleeding decreased by 57%.
Mortality due to sepsis increased by 50% in the second cohort, and led to death three times as often as in the earlier cohort, said Dr. Naik of the University of Texas at Dallas.
The etiology of cirrhosis changed from the earlier cohort to the later, with alcohol as a factor in 88% of patients in the first group and only 46% of the second, more recent group.
Dr. Naik said that it was not clear how many patients in each group also had hepatitis C, although he believed that it was a majority.
The most frequent causes of infection in these patients were pneumonia, bacteremia, and spontaneous bacterial peritonitis.
The study results suggest that clinicians should be more aware of the danger of infection in patients with cirrhosis, Dr. Naik said.
He reported no disclosures.