Bacterial Infection in Compensated Cirrhosis Predicts Inpatient Mortality and Readmission with Decompensation
1Weill Cornell Medicine, New York, NY, 2Cedars Sinai, Los Angeles, CA
Meeting: 2020 American Transplant Congress
Abstract number: 52
Keywords: Infection, Liver, Liver cirrhosis
Session Information
Session Name: Liver: Portal Hypertension and Other Complications of Cirrhosis
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 4:03pm-4:15pm
Location: Virtual
*Purpose: Identify the impact of bacterial infection on inpatient mortality and new decompensation in hospitalized patients with compensated cirrhosis from a nationally representative database.
*Methods: This study used the Nationwide Readmissions Database from 2011-2014 and included adults with cirrhosis without decompensation (ascites, encephalopathy, or variceal bleed). Patients admitted specifically for a liver or cancer diagnosis related group on index admission were excluded. The primary outcome was a composite of inpatient mortality and readmission with new decompensation. Bacterial infection included pneumonia, urinary tract infection (UTI), cellulitis, cholangitis, Clostridium difficile infection (CDI), and sepsis but not spontaneous bacterial peritonitis. Multivariable logistic regression analyzed the primary outcome and covariates were selected a priori. The sample was weighted to produce nationally representative estimates.
*Results: Of the 466,324 index admissions included, 25,987 (5.6%) died on index admission. 181,231 (38.9%) patients were readmitted, with 78,398 (43.3%) patients with new decompensation, and 19,808 (4.2%) who died on readmission. The cohort had a mean age of 60 years and was 40% female. The most common decompensation event was ascites (48.9%). Bacterial infection (24.0% vs. 17.6%, p<0.001) was significantly associated with the composite outcome - 9.2% died on admission, 13.1% had readmission with new decompensation, and 3.9% died on readmission. The table below shows that infection is significantly associated with the composite outcome on multivariable analysis.
| Variable | Adjusted OR | P-value |
| Bacterial infection | 1.22 (1.20-1.25) | <0.001 |
| Pneumonia | 1.25 (1.20-1.30) | <0.001 |
| Sepsis | 1.80 (1.74-1.86) | <0.001 |
| Cholangitis | 1.15 (1.03-1.29) | <0.001 |
| Clostridium difficile infection | 1.23 (1.14-1.33) | <0.001 |
Within bacterial infection, pneumonia, sepsis, cholangitis, and CDI were all independently associated with the composite endpoint.
*Conclusions: In a nationally representative inpatient cohort including over 400,000 index admissions of patients with compensated cirrhosis, nearly 10% died overall, over 1/3 were readmitted, over 40% of which had a new decompensation event. Bacterial infection in patients with compensated cirrhosis signals impending mortality or decompensation and should trigger early hepatology referral and consideration of transplantation evaluation in appropriate candidates.
To cite this abstract in AMA style:
Rosenblatt R, Jesudian A, Lucero C, Kaplan A, Brown RS, Sundaram V, Fortune B. Bacterial Infection in Compensated Cirrhosis Predicts Inpatient Mortality and Readmission with Decompensation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/bacterial-infection-in-compensated-cirrhosis-predicts-inpatient-mortality-and-readmission-with-decompensation/. Accessed May 16, 2025.« Back to 2020 American Transplant Congress