World Congress at ACG2017
Simultaneous Plenary Session 4A: Liver
59 - MELD Score Predicts Fungal Infections in Acute-on-Chronic Liver Failure Patients
Wednesday, October 18
9:30 AM - 9:40 AM
Location: Valencia Ballroom BC (Level 4)
Sandeep Yarlagadda, MD1, Nehali Patel, MD2, Chiu-Hsieh Hsu, PhD3, Courtney Walker, DO4, Sarah Patel, MD5, Shahid Habib, MD6
1Tucson Medical Center, Tucson, AZ; 2Kaiser Permanente, Fontana, CA; 3University of Arizona, Tucson, AZ; 4University of Utah, Salt Lake City, UT; 5University of Washington, Seattle, WA; 6Liver Institute, Tucson, AZ
Introduction: Microorganisms are not isolated in all acutely decompensated patients with infection. There are no known surrogate markers to differentiate between gram positive(GP), gram negative(GN) and fungal infections. Differentiating between these groups may help to initiate appropriate empiric antimicrobial therapy.
Methods: We categorized retrospective cohort of acutely decompensated cirrhosis patients with established diagnosis of infection into four groups based on the identified microorganism: 1) GP, 2) GN, 3) fungi and 4) unidentified organism (UIO). Diagnosis of infection in UIO group was strictly based on established criteria for SBP, septic arthritis, pneumonia and cellulitis. All baseline demographics, clinical and laboratory features were evaluated for each group. Primary end point was mortality. Regression analysis was performed.
Results: A total of 277 out of 457 patients were identified with established infection. The Infected cohort of 277 were diagnosed with either GP (n=43, 15.5%), GN (n=89, 32.1%), fungi (n=26, 9.4%) or UIO (n=119, 43%). All 4 groups were similar except PT/INR and PTT with regards to baseline characteristics including demographic and measures of severity of liver disease. UIO had mildly abnormal coagulation parameters with mean INR 1.61 and PTT 38.89 seconds. Entire cohort was analyzed for factors predictive of fungal infections. MELD score and Hb were the only factors associated with fungal infection. Logistic regression model including all significant variables with a p-value < 0.05 (i.e. MELD, Hb, PT, INR and total bilirubin) yielded a C-statistic of 0.74 (95% CI: 0.63, 0.84). Multinomial logistic regression was performed to derive odds ratio (95% CI) and p-value. Patients with fungal infections are more likely to have anemia, elevated bilirubin and alkaline phosphatase compared to GP or GN infections. Patients with UIO had mild coagulopathy. After adjusting for all the positive variables, elevated MELD was strongly associated with fungal infections. (p= < .01). Overall, patients with fungal infections had higher risk of death (HR 2.4,95 CI 1.35, 4.46, p=.003) compared to UIO. Patients with fungal infections were more likely to stay longer in the hospital (p=.04) and had higher readmission rates (p=0.01).
Discussion: Fungal infections are relatively common in decompensated cirrhotic patients and result in high mortality. Elevated MELD is strongly associated with fungal infections. Prospective trial is needed to confirm the findings.
Supported by Industry Grant: No
Citation: . MELD SCORE PREDICTS FUNGAL INFECTIONS IN ACUTE-ON-CHRONIC LIVER FAILURE PATIENTS. Program No. 59. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.