Patients with cirrhosis have a higher risk of infections
Individuals cannot be accounted for in the final analysis. In addition, attempts to explore possible etiologies of the associations are limited by the information that is included in the database. For example, the incidence of Gram-positive infections in cirrhotic individuals may be due to a line-related infection Viagra Store online resulting from the greater use of central venous catheterization, but the database was not designed for this type of inquiry. Inherently, studies of this type also cannot be assessed for type and appropriateness of care. Stratification by severity of illness or by severity of cirrhosis cannot be accomplished with this database.
Last, acute hepatic dysfunction is a potentially lethal complication of multiorgan dysfunction syndrome (MODS). Interposing mortality from MODS-related hepatic dysfunction with mortality from cirrhosis could influence the outcomes of sepsis and death. The inappropriate inclusion of mortality from MODS could lead to erroneous conclusions about the relationship between cirrhosis and poor outcomes during hospitalization. For this reason, the database also was analyzed for ICD9-CM code 570, acute and subacute necrosis of the liver (ie, hepatic failure). Only 18,000 hospital discharges were coded for acute hepatic failure, and only 1% of hospital discharges were concurrently coded with ICD9-CM code 570 (for hepatic failure) and ICD9-CM code 571 (for cirrhosis and chronic liver disease). Therefore, the relative infrequence of the acute hepatic failure diagnosis and concurrent coding lessens the possibility that this type of miscoding could account for the increased incidence of sepsis and death.
In conclusion, our study demonstrates that patients with cirrhosis have a higher risk of infections and are more likely to die as a result of those infections. On a national level, the preexistence of cirrhosis is a predictor of poor outcome when hospitalization is required for episodes of sepsis. Additional studies are required to determine the factors that predispose cirrhotic individuals to serious infections and the extent to which these factors are modifiable.
