Prevalence and in-hospital mortality trends of infections among patients with cirrhosis

A nationwide study of hospitalised patients in the United States

A. K. Singal, H. Salameh, Patrick Sequeira Kamath

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background Data on bacterial infections in hospitalised patients in the US with cirrhosis are derived largely from single centre data. Countrywide data in this population are lacking. Aim To assess prevalence of infections among hospitalised patients in the US and examine their impact on in-hospital mortality and health care resources utilisation. Methods Nationwide Inpatient Sample (1998-2007) was queried for hospitalisations with cirrhosis and examined for infections including spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI), skin and soft tissue infections, pneumonia and Clostridium difficile infections (CDI). In-hospital mortality, length of stay (LOS) and total charges were analysed. Results Of 742 391 admissions with cirrhosis, 168 654 (23%) had discharge diagnosis of any infection. Between 1998 and 2007, there was a trend towards increasing prevalence of infections (21-25%). Higher rates of infection were associated with ascites (22-25%) and renal insufficiency (RI) (38-43%). Infection with RI increased from 13% in 1998 to 27% in 2007. UTI was the most common infection (9-12%) followed by subcutaneous tissue infections (5-6%) and SBP (2-3%, around 12% in patients with ascites). Infection rate was similar among teaching and nonteaching hospitals with CDI and SBP being more common in teaching hospitals. In-hospital mortality was about 5%, over fivefold higher in infected cirrhotics, and associated with higher LOS and charges. Sepsis (38-42%), pneumonia (23-30%), SBP (16-23%) and CDI (11-16%) contributed most to in-hospital mortality. Conclusions The prevalence of infections among hospitalised patients with cirrhosis in the US is increasing and is associated with in-hospital mortality, renal insufficiency and costs.

Original languageEnglish (US)
Pages (from-to)105-112
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume40
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Hospital Mortality
Fibrosis
Infection
Peritonitis
Clostridium Infections
Clostridium difficile
Renal Insufficiency
Ascites
Urinary Tract Infections
Teaching Hospitals
Length of Stay
Pneumonia
Patient Acceptance of Health Care
Soft Tissue Infections
Health Resources
Subcutaneous Tissue
Bacterial Infections
Inpatients
Sepsis
Hospitalization

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

@article{7d707a8d42ef4e1fbd428e83814e0e59,
title = "Prevalence and in-hospital mortality trends of infections among patients with cirrhosis: A nationwide study of hospitalised patients in the United States",
abstract = "Background Data on bacterial infections in hospitalised patients in the US with cirrhosis are derived largely from single centre data. Countrywide data in this population are lacking. Aim To assess prevalence of infections among hospitalised patients in the US and examine their impact on in-hospital mortality and health care resources utilisation. Methods Nationwide Inpatient Sample (1998-2007) was queried for hospitalisations with cirrhosis and examined for infections including spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI), skin and soft tissue infections, pneumonia and Clostridium difficile infections (CDI). In-hospital mortality, length of stay (LOS) and total charges were analysed. Results Of 742 391 admissions with cirrhosis, 168 654 (23{\%}) had discharge diagnosis of any infection. Between 1998 and 2007, there was a trend towards increasing prevalence of infections (21-25{\%}). Higher rates of infection were associated with ascites (22-25{\%}) and renal insufficiency (RI) (38-43{\%}). Infection with RI increased from 13{\%} in 1998 to 27{\%} in 2007. UTI was the most common infection (9-12{\%}) followed by subcutaneous tissue infections (5-6{\%}) and SBP (2-3{\%}, around 12{\%} in patients with ascites). Infection rate was similar among teaching and nonteaching hospitals with CDI and SBP being more common in teaching hospitals. In-hospital mortality was about 5{\%}, over fivefold higher in infected cirrhotics, and associated with higher LOS and charges. Sepsis (38-42{\%}), pneumonia (23-30{\%}), SBP (16-23{\%}) and CDI (11-16{\%}) contributed most to in-hospital mortality. Conclusions The prevalence of infections among hospitalised patients with cirrhosis in the US is increasing and is associated with in-hospital mortality, renal insufficiency and costs.",
author = "Singal, {A. K.} and H. Salameh and Kamath, {Patrick Sequeira}",
year = "2014",
doi = "10.1111/apt.12797",
language = "English (US)",
volume = "40",
pages = "105--112",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Prevalence and in-hospital mortality trends of infections among patients with cirrhosis

T2 - A nationwide study of hospitalised patients in the United States

AU - Singal, A. K.

AU - Salameh, H.

AU - Kamath, Patrick Sequeira

PY - 2014

Y1 - 2014

N2 - Background Data on bacterial infections in hospitalised patients in the US with cirrhosis are derived largely from single centre data. Countrywide data in this population are lacking. Aim To assess prevalence of infections among hospitalised patients in the US and examine their impact on in-hospital mortality and health care resources utilisation. Methods Nationwide Inpatient Sample (1998-2007) was queried for hospitalisations with cirrhosis and examined for infections including spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI), skin and soft tissue infections, pneumonia and Clostridium difficile infections (CDI). In-hospital mortality, length of stay (LOS) and total charges were analysed. Results Of 742 391 admissions with cirrhosis, 168 654 (23%) had discharge diagnosis of any infection. Between 1998 and 2007, there was a trend towards increasing prevalence of infections (21-25%). Higher rates of infection were associated with ascites (22-25%) and renal insufficiency (RI) (38-43%). Infection with RI increased from 13% in 1998 to 27% in 2007. UTI was the most common infection (9-12%) followed by subcutaneous tissue infections (5-6%) and SBP (2-3%, around 12% in patients with ascites). Infection rate was similar among teaching and nonteaching hospitals with CDI and SBP being more common in teaching hospitals. In-hospital mortality was about 5%, over fivefold higher in infected cirrhotics, and associated with higher LOS and charges. Sepsis (38-42%), pneumonia (23-30%), SBP (16-23%) and CDI (11-16%) contributed most to in-hospital mortality. Conclusions The prevalence of infections among hospitalised patients with cirrhosis in the US is increasing and is associated with in-hospital mortality, renal insufficiency and costs.

AB - Background Data on bacterial infections in hospitalised patients in the US with cirrhosis are derived largely from single centre data. Countrywide data in this population are lacking. Aim To assess prevalence of infections among hospitalised patients in the US and examine their impact on in-hospital mortality and health care resources utilisation. Methods Nationwide Inpatient Sample (1998-2007) was queried for hospitalisations with cirrhosis and examined for infections including spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI), skin and soft tissue infections, pneumonia and Clostridium difficile infections (CDI). In-hospital mortality, length of stay (LOS) and total charges were analysed. Results Of 742 391 admissions with cirrhosis, 168 654 (23%) had discharge diagnosis of any infection. Between 1998 and 2007, there was a trend towards increasing prevalence of infections (21-25%). Higher rates of infection were associated with ascites (22-25%) and renal insufficiency (RI) (38-43%). Infection with RI increased from 13% in 1998 to 27% in 2007. UTI was the most common infection (9-12%) followed by subcutaneous tissue infections (5-6%) and SBP (2-3%, around 12% in patients with ascites). Infection rate was similar among teaching and nonteaching hospitals with CDI and SBP being more common in teaching hospitals. In-hospital mortality was about 5%, over fivefold higher in infected cirrhotics, and associated with higher LOS and charges. Sepsis (38-42%), pneumonia (23-30%), SBP (16-23%) and CDI (11-16%) contributed most to in-hospital mortality. Conclusions The prevalence of infections among hospitalised patients with cirrhosis in the US is increasing and is associated with in-hospital mortality, renal insufficiency and costs.

UR - http://www.scopus.com/inward/record.url?scp=84902186429&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902186429&partnerID=8YFLogxK

U2 - 10.1111/apt.12797

DO - 10.1111/apt.12797

M3 - Article

VL - 40

SP - 105

EP - 112

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 1

ER -