Bacterial infections can trigger the development of organ failure/s and acute-on-chronic liver failure (ACLF). Different geographic variations in their bacteriology and clinical practices could lead to different epidemiology, phenotypes and outcomes of ACLF around the world. The aim of the study was to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital.
This post hoc analysis included 1,175 decompensated cirrhotic patients with an admission or nosocomial bacterial infection from 6 geographic regions across the world, with collection of clinical, laboratory and microbiological data from infection diagnosis. Patients were followed for organ failure/s and ACLF development according to the EASL-CLIF criteria from enrolment to discharge.
333 patients (28%) had ACLF at infection diagnosis, while 230 patients developed ACLF after infection diagnosis, resulting in overall bacterial infection related-ACLF rate of 48%, but rates differed amongst different geographic regions, (38% in Southern Europe, 75% in the Indian subcontinent), affecting mostly younger (55±13 versus 58±14 years,) males (73%) with alcoholic cirrhosis (59% versus 45%), and a higher baseline MELD score (25±11 versus 16±5), (all p<0.001). Spontaneous bacterial peritonitis, pneumonia or infections caused by extensively drug resistant (XDR) bacteria were more frequently associated with ACLF development, with more ACLF patients having positive quick sequential organ failure assessment score, and septic shock, resulting in lower infection resolution rate (all p<0.001).
Bacterial infections, especially with XDR organisms, present the highest risks for ACLF development amongst patients with advanced liver and renal dysfunction. Geographic differences in these factors have resulted in variability in epidemiology, and clinical outcomes of bacterial infections and ACLF.

Copyright © 2020. Published by Elsevier B.V.