Title: Tu1556 - The Value of Ultrasound Based Elastographic Methods for Ruling Out the Presence of Esophageal Varices in Liver Cirrhotic Patients
Abstract: Background: Cirrhotic patients with upper gastrointestinal (GI) hemorrhage have high rates of bacterial infection.Short-term prophylactic antibiotics have been proven to reduce the risk of subsequent re-bleeding and death.No published studies have assessed the role of infection in cirrhotic patients who are admitted with lower GI bleeding.The aim of the study was to determine the prevalence of infection in cirrhotic patients with lower GI bleeding, risk factors for infection, and an association with re-bleeding and death.Methods: A single-center, retrospective cohort study of all adult, cirrhotic patients admitted to a tertiary care hospital for lower GI hemorrhage between 2005 and 2015 was performed.Utilizing the electronic medical record, prevalence of infection was calculated.Infected cirrhotic patients were statistically compared to uninfected patients to determine associations with 30-day re-bleeding and death as well as other demographic and clinical parameters.Results: 82 patients with 96 lower GI hemorrhage admissions were included.Average age was 65 years-old and 53% were men.Majority of patients had hepatitis C (49 patients) and were Child Pugh Score B (46%).The overall prevalence of infection was 27% (22 patients) within 10 days of initial GI hemorrhage.16% of all patients received prophylactic antibiotics upon admission, of which 47% were eventually diagnosed with an infection.Compared to uninfected patients, infected patients had a lower serum albumin (2.90 g/dL vs. 3.35 g/dL, p= 0.02) and were more likely to have renal failure (39% vs. 18%, p =0.03), systemic inflammatory response syndrome (26% vs. 8%, p=0.02),ICU admissions (39% vs. 18%, p=0.001), longer hospital length of stay (11.5d vs. 8.3d, p=0.04), and hemorrhoidal bleeding (22% vs. 10%, p=0.01).Infection was associated with increased 30-day mortality (n=3, 13% vs n=0, 0%, p=0.01), but not re-admission and re-bleeding.All patients who died had received prophylactic antibiotics.Conclusions: Cirrhotic patients admitted to the hospital for lower GI hemorrhage have a 27% rate of bacterial infection, which is associated with increased 30-day mortality.Future prospective studies are needed to clarify the role of infection and utility of antibiotic prophylaxis in this patient population.
Publication Year: 2018
Publication Date: 2018-05-01
Language: en
Type: article
Indexed In: ['crossref']
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