Renal failure & bacterial infections in cirrhosis: Epidemiology & clinical features.

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Hepatology. 2007 Jan;45(1):223-9.

Renal

failure and bacterial infections in patients with cirrhosis: Epidemiology and

clinical features.

Fasolato S, Angeli P, Dallagnese L, Maresio G, Zola E, Mazza E, Salinas F, Dona S, Fagiuoli S, Sticca A, Zanus G, Cillo U, Frasson I, Destro C, Gatta A.

Department of Clinical and Experimental Medicine, Padova, Italy.

The aim of the study was to investigate the prevalence and clinical course of

renal failure that was induced by the various types of bacterial infections in

patients with cirrhosis and ascites. Three hundred and

nine patients, who were consecutively admitted to the 3 major hospitals of Padova, Italy,

during the first 6 months of 2005, were studied prospectively.

Of these, 233 patients (75.4%) had evidence of ascites.

In 104 patients with cirrhosis and ascites (44.6%) a bacterial infection

was diagnosed. A bacterial infection-induced renal

failure was observed in 35 of 104 patients (33.6%). The

prevalence of renal failure was higher in biliary or gastrointestinal tract

infections and in spontaneous bacterial peritonitis (SBP) and in than in other

types of infections. In addition, the progressive form

of renal failure was only precipitated by biliary or gastrointestinal tract

infections, SBP, and urinary tract infections (UTI). In

a multivariate analysis only MELD score (P = 0.001), the peak count of neutrophil leukocyte in blood (P = 0.04), and the lack of

resolution of infection (P = 0.03) had an independent predictive value on the

occurrence of renal failure. Conclusion: The results

of the study show that the development of bacterial-induced renal failure in

patients with cirrhosis and ascites is related to the MELD score, and to both

the severity and the lack of resolution of the infection. A

progressive form of renal failure occurs only as a consequence of biliary or

gastrointestinal tract infections, SBP, and UTI. (HEPATOLOGY

2007;45:223-229.).

PMID: 17187409 [PubMed - in process]