Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis

Alcohol‐associated hepatitis (AAH) is a severe form of liver injury with mortality as high as 30%‐40% at 90 days. As a result of altered immune function in AAH, bacterial infections are common and are associated with poor outcomes. However, determining the risk and subsequent development of infectio...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Daniel D. Penrice, Serena Shah, Camille A. Kezer, Thoetchai Bee Peeraphatdit, Arun J. Sanyal, Brian Davis, Kristin C. Mara, Vijay H. Shah, Patrick S. Kamath, Douglas A. Simonetto
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/a7b0689d13874ebfa385b9a9cbefc261
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:a7b0689d13874ebfa385b9a9cbefc261
record_format	dspace
spelling	oai:doaj.org-article:a7b0689d13874ebfa385b9a9cbefc2612021-11-30T13:39:17ZRisk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis2471-254X10.1002/hep4.1786https://doaj.org/article/a7b0689d13874ebfa385b9a9cbefc2612021-12-01T00:00:00Zhttps://doi.org/10.1002/hep4.1786https://doaj.org/toc/2471-254XAlcohol‐associated hepatitis (AAH) is a severe form of liver injury with mortality as high as 30%‐40% at 90 days. As a result of altered immune function in AAH, bacterial infections are common and are associated with poor outcomes. However, determining the risk and subsequent development of infection in patients with AAH remain challenging. We performed a retrospective study of consecutive patients admitted with a diagnosis of AAH at two independent tertiary centers from 1998 to 2018 (test cohort, n = 286) who developed infections following hospitalization. The diagnosis of AAH was confirmed by manual chart review according to the recent National Institute on Alcohol Abuse and Alcoholism definition. Infections were categorized by location and time of diagnosis as hospital‐acquired infection (48 hours after admission until discharge) and posthospital infections (up to 6 months following discharge). The cohort was 66% men, and the median age was 48 (21‐83) years. Corticosteroids were used in 32% of all patients with AAH. The overall infection rate was 24%. Of those with infections, 46% were hospital acquired and 54% were acquired after hospitalization. Variables found to be significant risk factors for bacterial infection included the presence of ascites on admission (hazard ratio [HR], 2.06), corticosteroid administration (HR, 1.70), Model for End‐Stage Liver Disease (MELD) >23 (HR, 2.61), and white blood cell (WBC) count on admission per point (HR, 1.02). Conclusion: In this multicenter cohort study of patients hospitalized with AAH, MELD score, ascites, WBC count, and use of corticosteroids were identified as significant predictors of the development of bacterial infection. We created a novel predictive equation that may be used to aid in the identification of patients with AAH at high risk of infection.Daniel D. PenriceSerena ShahCamille A. KezerThoetchai Bee PeeraphatditArun J. SanyalBrian DavisKristin C. MaraVijay H. ShahPatrick S. KamathDouglas A. SimonettoWileyarticleDiseases of the digestive system. GastroenterologyRC799-869ENHepatology Communications, Vol 5, Iss 12, Pp 2096-2103 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 Daniel D. Penrice Serena Shah Camille A. Kezer Thoetchai Bee Peeraphatdit Arun J. Sanyal Brian Davis Kristin C. Mara Vijay H. Shah Patrick S. Kamath Douglas A. Simonetto Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis
description	Alcohol‐associated hepatitis (AAH) is a severe form of liver injury with mortality as high as 30%‐40% at 90 days. As a result of altered immune function in AAH, bacterial infections are common and are associated with poor outcomes. However, determining the risk and subsequent development of infection in patients with AAH remain challenging. We performed a retrospective study of consecutive patients admitted with a diagnosis of AAH at two independent tertiary centers from 1998 to 2018 (test cohort, n = 286) who developed infections following hospitalization. The diagnosis of AAH was confirmed by manual chart review according to the recent National Institute on Alcohol Abuse and Alcoholism definition. Infections were categorized by location and time of diagnosis as hospital‐acquired infection (48 hours after admission until discharge) and posthospital infections (up to 6 months following discharge). The cohort was 66% men, and the median age was 48 (21‐83) years. Corticosteroids were used in 32% of all patients with AAH. The overall infection rate was 24%. Of those with infections, 46% were hospital acquired and 54% were acquired after hospitalization. Variables found to be significant risk factors for bacterial infection included the presence of ascites on admission (hazard ratio [HR], 2.06), corticosteroid administration (HR, 1.70), Model for End‐Stage Liver Disease (MELD) >23 (HR, 2.61), and white blood cell (WBC) count on admission per point (HR, 1.02). Conclusion: In this multicenter cohort study of patients hospitalized with AAH, MELD score, ascites, WBC count, and use of corticosteroids were identified as significant predictors of the development of bacterial infection. We created a novel predictive equation that may be used to aid in the identification of patients with AAH at high risk of infection.
format	article
author	Daniel D. Penrice Serena Shah Camille A. Kezer Thoetchai Bee Peeraphatdit Arun J. Sanyal Brian Davis Kristin C. Mara Vijay H. Shah Patrick S. Kamath Douglas A. Simonetto
author_facet	Daniel D. Penrice Serena Shah Camille A. Kezer Thoetchai Bee Peeraphatdit Arun J. Sanyal Brian Davis Kristin C. Mara Vijay H. Shah Patrick S. Kamath Douglas A. Simonetto
author_sort	Daniel D. Penrice
title	Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis
title_short	Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis
title_full	Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis
title_fullStr	Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis
title_full_unstemmed	Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis
title_sort	risk prediction of nosocomial and posthospital discharge infections in alcohol‐associated hepatitis
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/a7b0689d13874ebfa385b9a9cbefc261
work_keys_str_mv	AT danieldpenrice riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT serenashah riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT camilleakezer riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT thoetchaibeepeeraphatdit riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT arunjsanyal riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT briandavis riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT kristincmara riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT vijayhshah riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT patrickskamath riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis AT douglasasimonetto riskpredictionofnosocomialandposthospitaldischargeinfectionsinalcoholassociatedhepatitis
_version_	1718406581895299072

Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol‐Associated Hepatitis

Ejemplares similares