Details

Autor(en) / Beteiligte

• Johansen, Stine
• Langkjær, Simon
• Rasmussen, Ditlev Nytoft
• Israelsen, Mads
• Torp, Nikolaj
• Lindvig, Katrine
• Kjærgaard, Maria
• Hansen, Johanne Kragh
• Hansen, Camilla Dalby
• Thorhauge, Katrine
• Andersen, Peter
• Detlefsen, Sönke
• Juel, Helene Bæk
• Justesen, Ulrik Stenz
• Hansen, Torben
• Krag, Aleksander
• Thiele, Maja
• Anastasiadou, Ema
• Arumugam, Manimozhian
• Bork, Peer
• Presto, Jenny
• Israelsen, Hans
• Karsdal, Morten
• Legido-Quigley, Cristina
• Melberg, Hans Olav
• Trebicka, Jonel
• Mann, Mathias
• Matthijnssens, Jelle

Titel

Infections increase the risk of decompensation and death in patients with early alcohol-related liver disease

Ist Teil von

• JHEP reports, 2024-04, Vol.6 (4), p.101016-101016, Article 101016

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2024

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Infections are frequent in patients with cirrhosis and worsen prognosis. We evaluated the incidence of infections and their impact on decompensation and death in patients with early alcohol-related liver disease (ALD) during long-term follow-up. We performed a prospective cohort study of patients in secondary care with a history of excess alcohol intake, no prior decompensation, and with liver biopsies along with clinical investigations conducted at baseline. During follow-up, we reviewed the patients’ electronic healthcare records for cases of infections, hospitalizations, transient elastography measurements, decompensations, all-cause mortality, and alcohol intake. We included 461 patients with a mean age of 56±10 years (76% males; fibrosis stage F0-1/F2/F3-4 = 259/107/93 [56%/23%/20%]). During a median follow-up of 4.5 years (IQR 2.9-6.3), 134 patients (29%) developed a total of 312 infections, most frequently pneumonia (106/312, 34%) and urinary tract infections (57/312, 18%). Excessive alcohol intake during follow-up, smoking ≥30 pack years, MELD score and elevated liver stiffness during follow-up were independent predictors of infections. Patients who developed at least one infection had a significantly increased risk of subsequent decompensation (hazard ratio 4.98, 95% CI 2.47-10.03) and death (hazard ratio 8.24, 95% CI 4.65-14.59). Infections increased the risk of decompensation and death independently of baseline fibrosis stage, age, gender, and MELD score. Almost one-third of patients with early ALD develop an infection, which worsens their prognosis by increasing the risk of decompensation and death. The risk of infections increases with liver disease severity and ongoing harmful use of alcohol. This study reveals that infections significantly worsen the prognosis of patients with early alcohol-related liver disease (ALD), increasing the likelihood of decompensation and death by up to eight times. These findings, pertinent to healthcare providers, researchers, and policymakers, emphasize the importance of early prevention and management of infections in patients with ALD, even those in early stages who may be asymptomatic. It was observed that nearly one-third of patients with early-stage ALD developed infections over 4.5 years, with risk factors including alcohol overuse, smoking, and higher MELD scores. The research underscores the critical need to incorporate these insights into clinical practice and public health policies to improve patient outcomes and mitigate the impact of infections in patients with ALD. [Display omitted] •Almost one-third of patients with early-stage alcohol-related liver disease developed infections during 4.5 years of follow-up.•Alcohol overuse, smoking, MELD score and a high transient elastography measurement independently predicted subsequent infections.•In patients with early-stage alcohol-related liver disease, infections increase the risk of death by up to 8-fold.