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首页> 外文期刊>World Journal of Gastroenterology >Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids
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Infection does not increase long-term mortality in patients with acute severe alcoholic hepatitis treated with corticosteroids

机译：糖皮质激素治疗的急性重症酒精性肝炎感染不会增加长期死亡率

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AIM To determine whether infection in patients with acute severe alcoholic hepatitis (AAH) treated with corticosteroids is associated with increased mortality. METHODS Consecutive patients with AAH were treated with steroids and recruited to the study. Clinically relevant infections (body temperature > 38 °C or 0.25 ×109/L, consolidation on chest radiograph or clinically relevant positive microbiological culture of bodily fluid) were recorded prospectively. Clinical and laboratory parameters were recorded and survival at 90 d and 6 mo was determined. Univariate analysis of factors associated with 90-d mortality was performed and significant variables included in a multivariate analysis. RESULTS Seventy-two patients were included in the final analysis (mean age 47.9 years, 26% female, mean discriminant function 53.0). Overall mortality in the group occurred in 15 (21%), 23 (32%) and 31 (43%) at day 28, day 90 and 1 year respectively. 36 (50%) had a clinically relevant infection during their hospitalisation (23 after initiation of steroids). The median time to development of incident infection after commencement of steroids was 10 d. The commonest site of infection was ascites (31%) and bacteraemia (31%) followed by urinary tract (19%) and respiratory tract (8%). Forty-one separate organisms were isolated in 33 patients; the most frequent genus was Escherichia (22%) and Enterococcus (20%). Infection was not associated with 90-d or 1 year mortality but was associated with higher creatinine, model for end-stage liver disease and Lille score. Baseline urea was the only independent predictor of 90-d mortality. CONCLUSION Clinically relevant infections are common in patients with AAH but are not associated with increased 90-d or 1 year mortality.
机译：目的确定用糖皮质激素治疗的急性重症酒精性肝炎（AAH）患者的感染是否与死亡率增加相关。方法连续性AAH患者接受类固醇治疗并被招募入研究。前瞻性记录临床相关感染（体温> 38°C或0.25×10 9 / L，在胸部X光片上巩固或临床相关的体液阳性微生物培养）。记录临床和实验室参数，并确定90 d和6 mo的存活率。对与90 d死亡率相关的因素进行单变量分析，并将重要变量纳入多变量分析。结果本研究共纳入72例患者（平均年龄47.9岁，女性26％，平均判别功能53.0）。在第28天，第90天和第1年，该组的总死亡率分别为15（21％），23（32％）和31（43％）。 36例（50％）在住院期间感染了临床相关感染（类固醇开始后23例）。类固醇开始治疗后发生事件感染的中位时间为10 d。最常见的感染部位是腹水（31％）和菌血症（31％），其次是尿路（19％）和呼吸道（8％）。在33例患者中分离出41种单独的微生物;最常见的属是大肠埃希菌（22％）和肠球菌（20％）。感染与90 d或1年死亡率无关，但与较高的肌酐，终末期肝病模型和里尔评分有关。基线尿素是90天死亡率的唯一独立预测因子。结论临床相关感染在AAH患者中很常见，但与90 d或1年死亡率增加无关。

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