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P58 Evaluating the impact of initial infection in patients presenting with decompensated cirrhosis (Analyses from the ATTIRE RCT cohort)
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P58 Evaluating the impact of initial infection in patients presenting with decompensated cirrhosis (Analyses from the ATTIRE RCT cohort)
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P58 Evaluating the impact of initial infection in patients presenting with decompensated cirrhosis (Analyses from the ATTIRE RCT cohort)
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Journal Article
P58 Evaluating the impact of initial infection in patients presenting with decompensated cirrhosis (Analyses from the ATTIRE RCT cohort)
2023
Overview
IntroductionInfection and systemic inflammation cause organ dysfunction and death in patients with decompensated cirrhosis. We aimed to characterise a subset of patients from the ATTIRE study who had infection at baseline presentation. (ATTIRE: Randomised Controlled Trial of Albumin infusions versus standard care in hospitalised patients with cirrhosis, DOI: 10.1056/NEJMoa2022166).MethodsPatients recruited to ATTIRE were analysed retrospectively. Multivariable analysis with binary logistic regression was used to identify factors affecting mortality in patients with evidence of initial infection at presentation. (Criteria for the diagnosis of initial infection can be found in the main ATTIRE trial paper referenced above).A subset of patients had available biomarker data, which were evaluated using ROC analysis to assess their performance in detecting infection.ResultsBaseline infection was present in 211/775 (27%) patients, and was associated with older age (age 55 years vs 53 years, p = 0.035). The presence of infection at baseline predicted mortality independently of age and MELD at: 14 days (OR 2.1, 95% CI 1.3–3.7, p = 0.006), 28 days (OR 1.6, 95% CI 1.1–2.6, p 0.028), 90 days (OR 1.8 95% CI 1.2–2.7, p <0.001) and 180 days (OR 1.5, 95% CI 1.05–2.1, p = 0.026). Antibiotics given at presentation did not confer any survival advantage at 14/28/90 days in patients with or without baseline infection.High LBP/low CD163 were associated with baseline infection in a smaller (n = 134) biomarker-subset (p=0.002/p= 0.03) (with high PCT nearing significance, p = 0.054). However, AUCs for these biomarkers for the prediction of baseline infection were all < 0.7.Of the 211 patients with baseline infection, co-occurring renal dysfunction in the first 14 days was the greatest predictor of 90-day mortality (OR 7.87 95% CI 3.07–20.2, p<0.001).Abstract P58 Figure 1Predictors of mortality in a) the whole ATTIRE cohort (n = 775) at 14 days, b) the whole ATTIRE cohort (n= 775) at 90 days, c) a subset of the ATTIRE cohort (n = 211) with baseline infection, at 90 days[Figure omitted. See PDF]DiscussionIn this cohort of patients presenting to hospital with decompensated cirrhosis, evidence of infection at presentation predicted mortality at 90-days, independently from MELD and age, with no survival benefit conferred from antibiotics in the absence of baseline infection.In such a high-risk group of patients, these results highlight the need to focus on the prevention of infection before decompensation occurs. The use of prophylactic antibiotics in patients with ascites is currently being evaluated in the ASEPTIC RCT (co-trimoxazole versus placebo in cirrhotic patients with ascites).
